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Forms Can Be Submitted via Email to ImcconoIogLie `i townofwappingemny.gov or 0
grobinson(v,towiiofwappingerny.gov or in person/via snail to 20 Middlebush Rd V4 appin NY 12590
FOR INTERNAL USE ONLY TOWN OF W1
�'P • A , p "to i�Qt r°ds
Application for Public; �c
Received by: Joseph P. Paolonl 1t
Lori McConologue
Grace Robinson
Date Received:
FOIL Ser. #:
I a N OLI Nl 0I MCI W
ASSESSOR
El
ACCOUNTING
�!
CODE ENFORCEMENT
HIGHWAY
RECEIVER OF TAXES
FORMAT OF RECORD (if available)
I 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
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
1 request that the records be faxed to the number listed above
RECREATION
El
SUPERVISOR
❑
TOWN CLERK
WATER/SEWER
DOG CONTROL OFFICER
TOWN ENGINEER
TOWN ATTORNEY
FMIPr r►'`
FOR DEPARTMENT USE ONLY
Date Received by Dept J /11 /
Department Head approval: nil
(init)
Date Applicant Contacted:
Date FOIL fulfilled or denied:
Closed by:
Date: I P 199
Notes: Crj0\1 0� S,Cjy-VeV�"
Amount Due: Pages for a total of 51
,50
Name: �'.,r�
l�i� �mC ®check here if you are
Address: I 6� 12 requesting that the records
k- be mailed to this address.
Agency or firm:
Telephone #: (rf 1 t) c 4(G FAX #: ( }
Email address:
SPECIFIC D,SCRIPTIO OF RECORD:
FORMAT OF RECORD (if available)
I 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
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
1 request that the records be faxed to the number listed above