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Forms Can Be Submitted via Email to lmcconologLie(@,townofwappingemy.gov or
grobinsonptownofwappingerny.gov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni 0
Lori McConoiogue
Grace Robinson ❑
Date Received: /, / ((- / 2'?
FOIL Ser. #: D-� - 20J0
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
❑
CODE ENFORCEMENT
[
HIGHWAY
❑
RECEIVER OF TAXES
❑
RECREATION
❑
SUPERVISOR
❑
TOWN CLERK
El
WATER/SEWER
❑
DOG CONTROL OFFICER ❑
TOWN ENGINEER
❑
TOWN ATTORNEY
--❑
I��ANNI?Gl'lrjG-
TOWN OF WAPPINGER
Application for Public Access to Records
9,ecely ed .FOIL .REQUEST
6c, 11 XW
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FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
v (init)
Date Applicant Contacted: L I lr 12 -
Date FOIL fulfilled or denied: fo
Closed by:
Date:
Notes:
Amount Due: Pages for a total of $
Name: - l u�O!�:) ❑check here if you are
Address: requesting that the records
be mailed to this address.
Agency or firm:
Telephone FAX #:
Email address: -_-
SPECIFIC DESCRIPTION OF RECORD:
FORMAT OF RECORD (if available)
I request to be notified when I can come to inspect the record(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