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Forms Can Be Submitted via Email to Imcconoto ue4,townofwappin erny.gov or
grobiiison(c�u,townofwappingemy.gov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni _j
Lori McConologue
Grace Robinson F
Date Received:
FOIL, Ser. #:
FINVATWOMM
ASSESSOR
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CODE ENFORCEMENT
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requesting that the records
RECEIVER OF TAXES
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RECREATION
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SUPERVISOR
TOWN CLERK
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WATER/SEWER
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DOG CONTROL OFFICERF-1
TOWN ENGINEER
TOWN ATTORNEY
TOWN k"iff WAPPMGER
Application for Public Access to Records
W-MANAININ-0,10
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Date Received by Dept
Department Head approval:
Date Applicant Contacted:
Date FOIL fulfilled or denied:
Closed by:
Date:
Notes:
Amount'11)ue: Pages for a total of S
Name:— A
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[check here if you are
Address:
requesting that the records
be mailed to this address.
Agency or film:
01
Telephone
FAX #:
Email address:
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
EZaccordance 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
R I request that the records be faxed to the number listed above