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Forms Can Be Submitted via Email to Imcconologue @townofwappinge=ffv or
giLo c6tow�jiofwa ppin emy�oy or in personJvia. mail to 20 Middlebush Rd Wappingers Falls, NY 12590
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FOR INTERNAL USE ONLY
Received by: Joseph P. Paolom 1-1
Lori McConologue
Grace Robinson 11
Date Received: / /
FOIL Ser. #: Qmro_�21__�C_
10 of VAII "y"L =1
ASSESSOR
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ACCOUNTING
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CODE ENFORCEMENT
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HIGHWAY
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RECEIVER OF TAXES
RECREATION
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SUPERVISOR
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TOWN CLERK
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WATER/SEWER
11
DOG CONTROL OFFICERM
TOWN ENGINEER
TOWN ATTORNEY
TOWN OF WAPPINGER
Apteation for Public rs to R cd;
FOIL RE
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BuiMrig Depar�
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FOR DEPARTMEI4T USE ONLY is
Date Received by Dept
Department Head approval:
Date Applicant Contacted:
ITI;)q
Date FOIL fulfilled or denied:
Closed by:
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Date:
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Notes: (f Vj'e�bcl-e, k _ �I - 1
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Amount Due: — Pages for a total of $ —
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Name:
Address:A e_
Agency or firm:
Telephone ft: 71tt
FAX #:
Email address:
check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD.
, 40 -
FORMAT OF RECORD (if available)
IH request 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
H 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