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Forms Can Be Submitted via Email to lnicconologLICC(r townofwappingerny. ov or
robinsoneetownofwa in ern . ov or in person/via mail to 20 Middlcbush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
RE' " Ive�,ppl cation for public Access to Records
Received by: Joseph P. Paoloni 1 FOIL REQ
Lori IVcConologue 7)
Grace Robinson FE ?024
Town n
Date Received: f d '
FOIL Ser. #: � Town I r :
Building I"tepartrnwt
DEPARTMENT:
TOWN OF' WAPPINGER
ASSESSOR
❑
ACCOUNTING
❑
CODE ENFORCEMENT
tR
HIGI-IWAY
RECEIVER OF TAXES
❑
RECREATION
❑
SUPERVISOR
❑
TOWN CLERK
❑
WATER/SEWER
❑
DOG CONTROL OFFICER ❑
TOWN ENGINEER
❑
TOWN ATTORNEY
0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
Date Applicant Contacted:
Date FDI fulfilled o denied
Closed by:
Date:
Notes: 21-60&L l .h
Amount Due: Pages for a total of
S f
Name: AfAlc. []check here if you are
Address: requesting that the records
" .rv� / be mailed to this address.
Agency or firm: [lMt&rL f '-L, rr.1ZVV�:- (:VM- .U77" -7 --
Telephone
,` "-7—.Telephone : ("ei 33 FAX :
Email address: - /I ji 6. c)A0. 1ilYt'.
SPECIFIC DESCRIPTION OF RECORD:
FORMAT OF RECORD (if available) 63S C 1
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