Klesse, Charies A.fps rGarq oFe s
,r
ennit Application
Return to: Town Clerk
Town of Wappinger
20 Middlebush Rd.
Wappingers Falls, NY 12590
Narne:(La
Address: 01 P'fQePCV i�Yi1�f'
( wt Address)
�YappingersFalls, NY 12590
(City) (ST) (Zip)
Phone: f2Sh.(�
Address of Sale:
(If different from. above) (street dress)
---Wappingers Falls. NY 12590
(City) (sI) (zip)
Date of Sale:p I%From: T (am until (UO( ay e) (Timeagn) a end)
:-) From: a pm) until ( pm
(Day Two)
From: (am/pm.) until (amIpm)
May TW(Time Segut) jE-0 EnTJ
Sign: - Date:
FOR 9 TAL USE ONLY
received by.
Date Received
Serial #;
Joseph P. Paoloni. ❑
Lauren. T, Ka.lmancy Q
Cooper M. Leatherwood ❑
1 I