Hatharn, KevinName:
Address:
Permit Application
Return to: Town Clerk
Town of Wappinger
20 Middlebush Rd.
Wappingers Falls, NY 12590
(Last) (`First ( I}
(Street Address)
Wappingers Falls, NY 12590
(City) (ST) (Zip)
Phone:
Address of Sale:
(If different from above) (street Address)
AUG
Town of Wappin9er
Town Clerk
Wappingers Falls, NY 12590
(City) (ST) (Zip)
Date of Sale: From: gx m) until 12— Al (amlpm)
(Day One) (Time Begin) (Time End)
From: (am/pm) until (am/pm)
(Day Two} (Time Begin) (Time End)
From: (am/pm) until (am/pm)
(Day Thr o) (Time Begin) (Tune End)
Sign: Date:
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FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni
Lynn O'Dell
Date Received: 1 I
Serial #: