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Forms Can Be Submitted via Entail to Irncconolo 7ue townofwappingemy.gov or
grobinson(aitownofwappingerny. ov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12.590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni 7]
Lora McConologue
Grace Robinson 71 ?
Date Received: /
FOIL Ser. Received:
A +
DEPARTMENT:
ASSESSOR
ACCOUNTING
❑
CODE ENFORCEMENT
HIGHWAY
F1
RECEIVER OF TAXES
❑
RECREATION
❑!
SUPERVISOR
❑
TOWN CLERK.
WATER/SEWER
❑
DOG CONTROL OFFICER El
TOWN ENGINEER
❑
TOWN ATTORNEY
7
Name:
Address:
TOWN OF WAPPINGER.
.pplication for Public Access to Records
��ghdflnrl Department
REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept UIL
Department Head approval:
Date Applicant Contacted: L2I ` I
Date FOIL fulfilled or denied: J /
Closed by:,
Date: / "
Notes. QrLj
Amoun Due: Pages for a total of $ —�
Agency or firm:
Telephone #: (' ,.; FAX #: ( )
Email address: "� r :.. a -i0AL:,' Cow -
F-1 check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION ITRECORD,
FORMAT OF RECORD (if available)
Irequest 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
E] 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