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Forms Can Be Submitted via Email to lmcconologuegtownofwappin erny, ov or
robinson(c townofwappingerny. ov or in person/via snail to 20 Middlebush Rd Wappingers Falls, NY 12.590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni
Lori McConologueI✓
Grace Robinson H
Date Received:
FOIL Ser. #: 0
DEPARTMENT
ASSESSOR
❑
ACCOUNTING
❑
CODE ENFORCEMENT
HIGHWAY
RECEIVER OF TAXES
El
RECREATION
11
SUPERVISOR
El
TOWN CLERK
❑
WATER/SEWER
[]
DOG CONTROL OFFICER ❑
TOWN ENGINEER
❑
TOWN ATTORNEY
❑
Name:
Address:
TOWN OF WAPPfNGER
Application for Public Access to Records
Received SOIL REQ
OCT 3
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pip \Napping
TnNNn � 4 ,rte
FOR DEPARTMENT USE ONLY
Date Reccivcd.by Dept /
Department Head approval:
Date Applicant Contacted:
Date FOI fulfilled r denied: f.. /�'
Closed by: ,° W %
Date: r ! /,,, _
Notes:
Amount Due; Pages for a total of $
EM ck here if you are
requesting that the records
/ be.mailed to this address.
Agency or firm:
Telephone #: ( - FAX #:-
Email address: 6rlit"/ are
SPECIFIC DESCRIPTION OF RECORD:640105 aE ,✓�
FORMAT OF RECORD (if available)
HIrequest 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