Acosta, Magdalenac ; Cjara e Sale Permit Application
r Return to: Town Clerk
Town of Wappinger
20 Middlebush Rd.
Wappingers Falls, NY 12590
Name:
(Last) ` (Figs - (MI)
Address: c L CA,LO I (�) V 14P- N
(Street ,Address)
Wappingers Falls, NY_ 12590
(City) (ST) (zip)
Phone: t <6q �� (p t
Address of Saler C
(If different from above) (street Address)
Wappingers Falls, NY 12590
(City) (ST) (Zip)
Date of Sale::._.__. From: apm) until _ (am n
DOne) (Tune Begiai) (Tine End)
-_
4 _ from: (aal] pril) -until�
(Day Two) (Tii..e Began) (T'inie End)
From: (am/pm) until (amlpm)
(Day Three) (Time Begin) (Time End)
Sign:Date: 4
------------------------------------------------
E(�C�OML�;L�%
1 -OWN ()r- WAPPINGEP
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni
Jessica Fulton
Date Received: / 1
Serial #:
14