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.forms Can Be Submitted via Email to lmcconologLie(a)towno:fwappingerny.gov or
grobins on(-btownofwappingerny.gov or in person/via mail to 20 Middlcbush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni 1
Lori McConologue
(.grace Robinson
Date Rcceived:
FOIL Ser. ##:
DEPARTMENT:
ASSESSOR
_
ACCOUNTING
❑
CGDE ENFORCEMENT
,
HIGHWAY
❑
RECEIVER OF TAXES
❑
RECREATION
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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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FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
(init)
Date Applicant Contacted. /yy1
Date OIL 1 ill`d or denied:
Closed by:rl/
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Date: a
Notes:
Amount°Due: „/ Pages for a total of
Name:
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Address:
,
requesting that the records
be mailed to this address,
Agency or fin -n:
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I request copies of the records described above and agree to pay the cost of such records in
Tele bone ##:
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Email address:
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SPECIFI DESCRIPTION O D:
FORMAT OF RECORD (if available)
HIrequest
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