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Forms Can Be Submitted via Ernail to Imcconolo Tue 4townofwa yin cern . ov or
grob'insonq townofwappin crny, ov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY ° TOWN OF WAPPINGER
A licati fo P N1' A t R ids
Received by: Joseph P. Paoloni
Lori McConologue
Grace Robinson I
Date Received:
FOIL Ser. #:
Ma41alOka yi 1 WON0
ASSESSOR
❑
ACCOUNTING
❑
CODE ENFORCEMENT
HIGHWAY
Q
RECEIVER OF TAXES
0
RECREATION
SUPERVISOR
TOWN CLERK
El
WATER/SEWER
❑
DOG CONTROL OFFICER ❑
TOWN ENGINEER
0
TOWN ATTORNEY
[l
Name:
Address:
FF 0l1 r It 1C C�Ce00 o eCoREOUEST
111111IM111,1111"If"'
FOR DEPARTMENT USE ONLY
Date Received by Dept I /
Department Ilead approval:
(init)
Date Applicant Contacted: IV I I 00
Date FOIL fulfilled or denied: / /
Closed by: e4we-e=
Date:
f 1 /
Notes: 0.
Amount Due: Pages for a total of S
Agency or firm:
Telephone #: (,fir l')t _ .... FAX # :
Emil address:
check here if you are
requesting that the records
J be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
F07MAT OF RECORD (if available)
HIrequest 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
❑ I request that the records be sent via e-mail to the address listed above
0 I request that the records be faked to the number listed above