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Forms Can Be Submitted via Email to Imccojaologtie(c townofwappin crny,gov or
robinson cr?townofwa in ern ov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloi
Lori McConologue
Grace Robinson
Date Rcceived: / I
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
❑
CODE ENFORCEMENT
HIGHWAY
❑
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41
RECEIVER OF TAXES
❑
IH requesto be notified when I can come to inspect the record(s) described above
RECREATION
0
SUPERVISOR
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TOWN CLERK
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WATER/SEWER
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DOG CONTROL OFFICER ❑
TOWN ENGINEER
❑
TOWN ATTORNEY
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TOWN OF WAPPI GER
Application for Public Access to Records
.mm� IL T UEST
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FOR DEPARTMENT USE ONLY
Date Received by Dept, //"
Department Head approval:
Date Applicant Contacted: I / / Adq
Date FOI ilfilNe �r denied: 0 /
Closed by:
Date: t'ro (��k
Notes: I' lyb1zi r
Amount uee: Pages for a total of $
Name: ( 1W,j n4e []check here if you are
Address: _r ) L A 6LI, requesting that the records
a�f # RG`" be mailed to this address.
Agency
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Email address: a # t' ) Ld d0 art (@ -Twl d_.`r LA A
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)' °� -706Z-
0 lIrequest
IH requesto 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