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Forms Can Be Submitted via Email to lmcconolOgLie i,townotwa iirn 7erti . ov or
g_robinson�r?townoftvappi.n,gerny.gov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni
Lori McConologue -1
Grace Robinson
Date Received:
FOIL Ser. #:
DEPARTMENT:
T
ASSESSOR
❑'I
ACCOUNTING
CODE ENFORCEMENT
HIGHWAY
[]
RECEIVER OF TAXES
El
RECREATION
❑
SUPERVISOR
❑
TOWN CLERK
El
WATER/SEWER
El
DOG CONTROL OFFICER [J
TOWN ENGINEER
TOWN ATTORNEY
❑
Name:
Address:
T01WN OF WAPPfNGER
Application for Public Access to Records
FOIL REO UEST
FOR DEPARTMENT USE ONLY
Date Received by Dept ' / /
Department Head approval:
(init)
Date Applicant Contacted: � f % /
Date FOIL fulfilled or denied: � / /
Closed by:
Date:
1//
Notes: ff,V e� 01lil p`
Amount Due: — Pages for a total of $
Agency or firm:
Telephone #: FAX #:
Email address:
❑check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
b
FORMAT OF RECORD (if available)
IHrequest 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 cast 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