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Can Ike Subm l ed is Emato lrccoilofOgLi (iDtownofwappinefore g rD gov or I k y
robinson Gc�townof�va in Tern . xov or in person/via mail to 20 Middlebush Rd. Wappingers Falls, 12590
FOR INTERNAL USE ONLY
Received by: Joseph. P Paolon 1
Lori McConologue
Grace Robinson F
Date Received: 1
FOIL Ser. ##: 1910- a % _33
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
CODE ENFORCEMENT
HIGHWAY
RECEIVER OF TAXES
RECREATION
[]
SUPERVISOR
TOWN CLERK.
El
WATER/SEER
❑
DOG CONTROL OFFICER ❑
TOWN ENGINEER
El
TOWN ATTORNEY
❑
TOWN OF WAPPINGEI
Application for Public Access to Records
EO
Bui ding Departrn(,ntMMw
___.
"town oaf Wappincger
W. 11`
FOR DEPARTMENT USE ONLY
Date Received by Dept _L / gqJ
Department Head approval: 61
Date Applicant Contacted: /Q /
m%
Date FOIL fulfilled or denied: " /
Closed by:
Date: / -7
Notes: PMGt "Y C o "-C,w aw
Amount Due: for a total of
Name: ° C, f ❑check here if you are
Address: requesting that the records
awa , r % '&" be :mailed to this address.
Agency or firm: I f C)
Telephone FAX #: ) -
Email address: ..... e_ SZI? &Z ' ... c zE
SPECIFIC DESCRIPTION OF RECORD:
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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
I request that the records be faxed to the number listed above