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Forn-is Can Be Submitted via Email to linecono_��!,e
10 jj town o fwappi ng,��,o , oi-
ly, ob] . nsoLi(Ltjo. -,ov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paolom Ll
Lori McConologue I
Grace Robinson
Date Received:
FOIL Ser. #:
ASSESSOR
El'
ACCOUNTING
Date:
CODE ENFORCEMENT
Notes: Vnq�_ie
HIGHWAY
F-1
RECEIVER OF TAXES
Pages for a total of
RECREATION
SUPERVISOR
El
TOWN CLERK
WATFR/SEWER
DOG CONTROL OFFICER
TOWN ENGINEER
TOWN ATTORNEY
Application for Public Access to Records
r _��C�C � �W4L REO UEST
FP
FOR DEPARTMENT USE ONLY
Date Received by Dept —2-/
Departnient Head approval: i54 to
ry
Date Applicant Contacted: /4!5 / _2_5
Date FOIL fulfilled or denied: IS / '9'5
Closed by:
—61
Date:
q //5
Notes: Vnq�_ie
Amount Due: I
4
Pages for a total of
Name: c'�\4 — no. c"', ,®cheep here if you are
Address: c- � r) 5 requesting that the records
be mailed to this address.
Agency or firm:
Telephone #=
(j,3 FAX #:
Email address: t_" c_., cL
SPECIFIC DESCRIPTION OF RECORD:
0
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 taxed to the number listed above