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Forms Can Be Submitted via Email to ImeconologueL&townofwappingerny. ov or
grobinson townof appairl,gerny.goy or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph. P. Paoloni I
Lori McConologue
Grace Robinson F
Date Received: J 1
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
M
CODE ENFORCEMENT
HIGHWAY
M
RECEIVER OF TAXES
Date FOIL fulfilled or denied:
RECREATION
❑
SUPERVISOR
❑
TOWN CLERK.
❑
WATER/SEWER
❑
DOG CONTROL OFFICER ❑
TOWN ENGINEER
TOWN ATTORNEY
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rTOWN OF v'APPI G R
ADDlication for Public Access to Records
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FOR DEPARTMENT USE ONLY
Date Received by Dcpt
J1
Department Head approval:
P c..
Date Applicant Contacted:
1,901 t
Date FOIL fulfilled or denied:
1 c 4 1
Closed by:
Date: l x 1
Notes: 4 Y[sf> cs' Leg. (4-
Amount
4
Amount Due: – Pages for a total of $ —
Name: , C check here if you are
Address: e,- requesting that the records
f -3 be mailed to this address.
Agency or firm:�
Telephone #: ( ) 7--4cp - 0 FAX #:
Email address: 1,rt
SPECIFIC DESCRIPTION OF RECORD:
P c..
FORMAT OF RECORD (if available)
IHrequest 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