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Forms Can. Be Submitted via Email to kmcconologueLetownofwappingerny.gov or
gr binson@townofwappingernov or itt person/via mail t 3 �it h Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni
Lori McConologue I
Grace Robinson
Date Received: C9 / `94
FOIL Ser, #: z3
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
❑
CODE ENFORCEMENT
,
HIGHWAY
❑
RECEIVER OF TAXES
FOR -MAT OF RECORD (if available) am '
RECREATION
El
SUPERVISOR
El
TOWN CLERK
❑
WATER/SEWER
❑
DOG CONTROL OFFICER
TOWN ENGINEER
TOWN ATTORNEY
Name:
Address:
wn 0�f 'O'S WAPPINGER
AppTication for Public Access to Records
IL REQUEST
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FOR DEPARTMENT USE ONLY
Date Received by Dept f -}
Department Head approval:
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Date Applicant Contacted:
Date FOI fulfilled denied.
Closed by.
Date:
Notes:
Amount Due: Pages for a total of $
Agency or firth: f
Telephone #: ( ~�) <-1 _ 2j FAX #: ( )
Email address: l`°° V i t. elf l ' n, w.
❑check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
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FOR -MAT OF RECORD (if available) am '
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