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Forms Can Be Submitted via Email to IllICCOIIOIC)ULIe(ii)tO,,VIIOf�V I Y.90—V or in person/via mail to 20
Middlebusb Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni
Lori McConologue
Date Received:
FOIL Ser. #::'-C
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DEPARTMENT:
ASSESSOR
CODE ENFO
ZONING
FIRE INSPECTOR
HIGHWAY
RECEIVER OF TAXES
RECREATION
SUPERVISOR
TOWN CLERK
WATER/SEWER
DOG CONTROL OFFICER
TOWN ENGINEER
TOWN ATTORNEY
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FORDEPARTMENTUSE ONLY-_`
Date Received by Dept
Department Head approval:
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Date Applicant Contacted:
Date FOTI(fulfilled Ar denied: 7 Jb' /'P'3
Closed by:
Date:
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Notes:
Amount Due: — Pages for a total of $
Name: MA64D�,
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Address: 1,0 ) C- � t tj requesting that the records
be mailed to this address.
Agency or fine: R& j Lt I+ -,o L-�'U\j
Telephone #: (bY �j FAX #:
Email address: V-0 LA
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SPECIFIC DESCRIPTION OF RECORD:
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PUR-MATOF RECORD (if available)
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I request to be notified when I can come to inspect the rceord(s) described above
I request copies of the records described above and agree to pay the cost of such records in
accordance with the fee schedule on the back of this application
I request that the records be sent via e-mail to the address listed above
I request that the records be faxed to the number listed above