Acosta, Magdalena (2)Return to:
Narne:
(Last)
M I)
Address:
(Street Address)
Town Clerk
Town of Wappinger
20 Middlebush Rd.
Wappingers Falls, NY 12590
I rod E (C-91
Wappingers FallsNY— 12590
(City)
(ST) (Zip) 0 4 2920
Phone: (Sq 7 7 1- bl Ij) -()WN OF WAPPINGF'
Address of Sale:
re
(if different from above) (street T ' MISS)
Wappingers Falls, NY 12590
(City) (ST) (zip)
Date of Sale: From: a_pm.) until ,ir' (arr(@
) I
Vay one) (Tinle Begin) �' (Th e End)
From: aj�qpM) Until (arn
Clay Two) Frolle Begin) - (Time End)
From: _ (am/prn) until (am/pm)
(Day Three) (Time Begin) (Time End)
Sign-. Date: 0
_t -4ci
FOR INTERNAL USE ONLY
Received by: Joseph P. Paolom
Grace Robinson
Date Received:
Serial