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Forms Can Be Submitted via Email to hiiccoiiologue(a),towiiofwappingemy.gov of
grobiiisoii�townofwappiiigemy.,gov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni Ll
Lori McConologue Cl/
Grace Robinson F-1
Date Received:
FOIL Ser. #: abal
DEPARTMENT:
ASSESSOR 0
ACCOUNTING
F-1
E/
CODE ENFORCEMENT
HIGHWAY
F]
RECEIVER OF TAXES
❑
RECREATION
FORMAT OF RECORD (if available)
IH 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
E] I request that the records be sent via e-mail to the address listed above
F I request that the records be faxed to the number listed above
SUPERVISOR
TOWN CLERK
WATERJSEWER
DOG CONTROL OFFICER
TOWN ENGINEER
❑
TOWN ATTORNEY
TOWN OF WAPPMGER
Application for Public Access to Records
FOIL REO VEST
FOR DEPARTMENT USE ONLY
Date Received by Dept NQ /J 7 / 03
Department I -lead approval:
(init)
Date Applicant Contacted: -if) /'�!/ / '2a
Date FOIL fulfilled or denied:LL121123-
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Closed by: z
Date: " s
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Amount Due '-)-- Pages fora total of $,
Name: Ae,,4,LXej check here if you are
Address: requesting that the records
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Agency or firm: - I I T f
Telephone #: -yZj- fOS FAX #:
Email address: A ez1-- -- e So 1'/'z C &0- Zei4 "t. ---f
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
IH 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
E] I request that the records be sent via e-mail to the address listed above
F I request that the records be faxed to the number listed above