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Forms Can Be Submitted via Email to lmcconologLie(c�,townofw;rappingerny., ov or �
grobinson(c�townofwa ' er�7y ov or in person/via mail to 20 iddlebush Rd Wapping W( s, NY 12590
FOR INTERNAL. USE ONLY TOWN OF WAPPIN,,11«
Application for Pu ,l� ',A'& `ss M%8 �� o ds
Received by: Joseph P. Paoloni -1,
RE
Lori !v'[cConologue
Grace Robinson Fi
Date :Received:
FOIL Ser. #:-
ffld ng De partm"rent.
DEPARTMENT: to �r.� 47F��r�t�'�� i� oE;tt
ASSESSOR ❑ n FOR DEPARTMENT USE ONLY
ACCOUNTING
CODE ENFORCEMENT ❑ Date Received by Dcpt 1 J
HIGHWAY
F-1Department Head approval:
"-
RECEIVER OF TAXES `(pmt)
RECREATION
Date Applicant Contacted:
SUPERVISOR
TOWN CLERK [❑ Date FOIL filld or denied:
WATER/SEER ❑
DOG CONTROL OFFICER ❑ Closed by: (11
TOWN ENGINEER ® Date: ! 1
TOWN ATTORNEY ® /y
Notes:
Amount Due: /° Pages for a total of $
Name: J ,�✓" t G-;r� eck here if you are
Address: zf1 f� v�.l�" 'r,ref-, '�? questin that the records
be mailed to this address.
Agency or firm:
Telephone #: (qlq
Email address:
f72 FAN #:
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
❑1 request that the records be faxed to the number listed above