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Forms Can Be Submitted via Email to Imccoiiologue(cytownofwappingemy.gov or
grobinsoiiptownofwapip2ingerny.gov or in person/via mail to 20 Mddlebush. Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni 7
Lori McConologue F -1i
Grace Robinson E
Date Received
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
0
ACCOUNTING
CODE ENFORCEMENT
HIGHWAY
0
RECEIVER OF TAXES
C]
RECREATION
01
SUPERVISOR
TOWN CLERK.
0
WATER/SEWER
DOG CONTROL OFFICEREJ
TOWN ENGINEER
TOWN ATTORNEY
0
TOWN OF WAPPMGER
Application for Public Access to Records
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Erlirig Depa trnWlt
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'OIL RT UEST
FOR DEPARTMENT USE ONLY
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Date Received by Dept LO I, ✓' 3 '� ""
Department. Head approval:
Date Applicant Contacted:
Date FO fulfilled r denied: /V/ // dp) _..
Closed by:
Dake:
re,
Notes:
Amount Due: Pages for a total of $
Name: Marcus Ulloa Dchcck here if you are
Address: 17 Robin Ln requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: ( acs ) ass - 5213 FAX #: ( } -
Email address: rmarcusulloa@gmail.comn
SPECIFIC DESCRIPTION OF RECORD:
Looking for land survey of address to rind out where septic tank and leach field hs.
FORMAT OF RECORD (if available)
61)__
Irequest 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