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Forms Can Be Submitted via Email to Imcconologuecatownafwappingerny,gov or
grobinson ,townofwappingemy.gov_ or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY I2590
FOR INTERNAL USE ONLY
Received by: Joseph. P. Paoloni
Lori McConologue
Grace Robinson E
Date Received: / 1
FOIL Ser. : 010c -
ASSESSOR
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ACCOUNTING
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CODE ENFORCEMENT
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HIGHWAY
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RECEIVER OF TAXES
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RECREATION
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SUPERVISOR
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TOWN CLERK
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WATER/SEWER
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DOG CONTROL OFFICER
I request that the records be faxed to the number listed above
TOWN ENGINEER
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TOWN ATTORNEY
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TOWN OF WAPPINGER
A + kation for Public Access to Records
OIL REQUEST
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FOR DEPARTMENT USE ONLY
Date Received by Dept 0 /,;,
Department Head approval: C .
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Date Applicant Contacted: /r
Date :FOIL fulfilled or denied: E 1,2 12
Closed by:
Date:
Notes:.a
Amount Due: Pages for a total of
Name: 5 L j ' ' �r 6� L l.,C /,hz r„ur c)LL❑ check here if you are
Address: requesting that the records
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Agency or firm:
Telephone #: (SY')" ) kjj = /U c�,6? FAX #: ( ) -
Email address: �a✓'� 6. c.su
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
HIrequest
to be notified when I can came to inspect the record(s) described above
I request copies of the records described above and agree to pay the cast of such records in
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accordance with the fee schedule on the back of this application
be listed
I request that: the records sent via e-mail to the address above
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I request that the records be faxed to the number listed above