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Forms Can Be Submitted via Email to Imcconologtie(�?townofwappingeniy.gov or
rnobinson @townofwappingerny.go or in person/via mail to 20 Middlebush Rd. Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni -j
Lori McConologue
Grace Robinson P
Date Received: _/_/
FOIL Ser. :
DEPARTMENT:
ASSESSOR
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ACCOUNTING
CODE ENFORCEMENT
WFI
HIGHWAY
RECEIVER OF TAXES
❑
RECREATION
El
SUPERVISOR
O
TOWN CLERK.
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WATER/SEWER
❑
DOG CONTROL OFFICER
TOWN ENGINEER
TOWN ATTORNEY
Name: v 's - (?"
Address: �i U (
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TOWN OF WAPPINGER
Application for Public Access to Rec rtls
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FOR DEPARTMENT USE ONLY
Date Received by Dept LL
Department Head approval:
i
Date Applicant Contacted: ) / / 9 /2
Date FOIL fulfilled or denied: / ✓
Closed by:
Date:
Notes:
Amount Due: ___7 Pages for a total of $
F-1 check here if you are
" requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: /. ) - FAX ( }
Email address:
SPECIFIC DESCRIPTION OF RECORD:
( 0/L/ ,q us e,
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
I request that the records be faxed to the number listed above
Russell Pisano
Town of Wappinger
20 Middlebush Rd.
Wappingers Falls, NY 12590
(845) 297-6256
FEES PAID
Reference:
6258-03-015012-0000
Pisano, Russell
29 Blackthorn Lp
11/08/2023
®ate Fee Check No. Receipt No. PayType Amount
11/08 2023 I COPIES 2023-02191 1 CASH $1.75
This is a receipt for payment of fees. This is not a building permit.
Date Printed: 11/08/2023