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Forms Can Be Submitted via Etnail to liiiecotiolo-,ue4'i towjiot"va.ptaiqga.� or
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FOR I TERNAL USE ONLY
Received by: Joseph P. Paeloni t� -
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Grace Robinson ❑
Date Received- d I
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TOWN ATTORNEY
HIrequest to be notified when I can come
TOWN OF WAPPINGER
Application for PublicAccess to Records
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Date Received by Dept
Dep 'rtment Head approval:
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Date FOO fulfilled r denied:
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Amount Due: Pages for a'total of
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Address: requesting that the records
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Email address: a, lob -X :44�, QN14 ln.' . Cta Yh
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FORMAT OF RECORD (if available)
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HIrequest 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
I request that the records be sent via e -m
itch of this application
it to the address listed above