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f,_omis Can Be Submitted via mail to Imcconologuegtowiiofwappingemy.go,v or
grobi ison,-4townofwa in em . go v or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12.590
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FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni F]
Lori McConologue
Grace Robinson Fj
Date Received: _/_/
FOIL Ser. #: 1U �711 —
DEPARTMENT:
Name: �chcck here if you are
ASSESSOR
Address: requesting that the records
ACCOUNTING
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CODE ENFORCEMENT
Agency or firm:
HIGHWAY
Telephone #: Oq _3 FAX
RECEIVER OF TAXES
Email address:
RECREATION
SUPERVISOR
El
TOWN CLERK
El
WATER/SEWER
DOG CONTROL OFFICER
TOWN ENGINEER
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TOWN ATTORNEY
TOWN OF WAPPINGER
Application for Public4�_cF 5 to, Re ords
FOIL RE
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Receive
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I &Odirlg Departrno(° t
IOWN OF WAPPINGEF(
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
Date Applicant Contacted: I L / V" / z "S
Date FOIL fulfilled or denied:
Closed by:
Date: �5 J5
Notes:
Amount Due: _ Pages for a total of $
Name: �chcck here if you are
Address: requesting that the records
1AAW1 r) ✓ be mailed to this address.
Agency or firm:
Telephone #: Oq _3 FAX
Email address:
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available) Z3 3,3?9 cb
IH request to be notified when I can come to inspect the recor,d(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.
listed
I request that the records be sent via e-mail to the address above
I request that the records be faxed to the number listed above