Santini, DonnaAddress:
(Street Address)
Wappingers Falls, NY
A�,- (city) (ST)
Phone: (i� ,1yan
rmit Application
ern to: Town clerk
Town of Wappinger
20 Middlebush Rd.
Wappingers Falls, NY 12590
R,eeeived
JUL 1 � 202,
1Zp90 Town of 1Neppinger
To\Ni Clerk
Address of Sale: / Od
(If different f om above) ( eet ress)
Wappingers Falls, NY 12590
(City) (ST) (Zip)
Date of Sale: From:- ar 1pm) until 3(am/ i
/ayOne) (Tune Begin) (Time End)
From.: (am/pm) until (am/pm)
(Day Two) (Time Begin) (Time End)
From: (am/pm) until (am/pm)
(Day Three) (Time Begin) (Time End)
Sign: Date:
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FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni
Lynn O'Dell
Date Received: 1 I
Serial #: