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Forms Can Be Submitted via Email to lrncconalogue townof +appingemy-gov or
grobinson cbtownof appin,gerny.goov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni 11
Dori McConologUe
Grace Robinson F
Date Received:
FOIL Ser, #:
DEPARTMENT:
ASSESSOR
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ACCOUNTING
CODE ENFORCEMENT
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RECEIVER OF TAXES
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RECREATION
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SUPERVISOR
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TOWN CLERK
accordance with the fee schedule on the back of this application
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WATER/SEWER
request that the records be sent via e-mail to the address listed above
DOCS CONTROL OFFICER
TOWN ENGINEER
TOWN AT'T'ORNEY
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TOWN OF WAPPfNGER
Application for Public Access to Records
REO UEST
FOR DEPARTMENT USE ONLY
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Date Received by Dept
Department Head approval:
(init)
Date Applicant Contacted:
Date FOIL! fi Ted or denied:
Closed by:
Date:
Notes:,
Amount Due: Pages for a total of
Name: jsg 6AKC—e-r4M Qcheck here if you are
Address: 5-o ce. der 4-d- �ye5-f 1���� i t?U requesting that the records
be mailed to this address.
Agency or firm:
Telephone : ( 41) 5 - l 33 T FAX #:
Email address: 12 j Mo NP cL,r'-"
SPECIFIC DESCRIPTION OF RECORD:
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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
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request that the records be faxed to the number listed above