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Fortes Can Be Submitted via Email to 1.mccoaaologueCebtowvnofwvapl2ingerny., ov or
rrobinson cr)tow iiofwa ir7 ern ov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12500
FOR INTERNAL USE ONLY
Received by: Joseph P. Paolon.i 1
Lori McConologue
Grace Robinson
Date Received: /
FOIL Ser. : �.
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
Departmei Head approval:
CODE ENFORCEMENT
HIGHWAY
❑
RECEIVER OF TAXES
Date FO l eVir denied:
RECREATION
❑
SUPERVISOR
❑
TOWN CLERK
Date:
WATER/SEWER
�❑
DOG CONTROL OFFICER
TOWN ENGINEER
�❑
TOWN ATTORNEY
request that the records be faxed to the number listed above
TOWN OF WAPPIN ER
Wication,.for Public Access to Records
1''i LJildi" 1F7 D pay� ic.nt,
I ow n r,r VUaElg�t'Elr
REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept,
1 /
Departmei Head approval:
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Date li Contac
/q -/x
Date FO l eVir denied:
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FORMAT OF RECORD (if available)
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I request to be notified when I can carne to inspect the record(s) described above
Date:
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Notes: � .£
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Amount Due: Pages for a total -'/of of
Narne: � l-'� ❑check here if you are
Address: LID C ) t 5requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: (SL),5) i -" FAX #: ( )
Email address: c. `�trec% `v , c . C
SPECIFIC DESCRIPTION OF RECORD: . P S 6 -- 0 ) — Y 3_/ -%
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FORMAT OF RECORD (if available)
I request to be notified when I can carne 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 be listed
request that the records sent via e-mail to the address above
❑1
request that the records be faxed to the number listed above