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Forms Can Be Submitted via Email to Imcconologue &,,townofwapRin,gerray.gov or
robinson c townofwa in enr . ov or in person/via mail to 20 1Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni
Lori McConologue Llp
Grace Robinson F]
Date Received: / I
FOIL ser. : W
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ASSESSOR
ACCOUNTING
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CODE ENFORCEMENT
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HIGHWAY
RECEIVER OF TAXES
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RECREATION
SUPERVISOR
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TOWN CLERK
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WATER/SEWER
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DOG CONTROL OFFICER ❑
TOWN ENGINEER
F
TOWN ATTORNEY
I request that the records be faxed to the number listed above
Narne
Address:
Application for Public Access to Records
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FOR DEPARTMENT USE ONLY
Date Received by Dept /
Department Head approval:
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Date Applicant. Contacted: / lgv
Date FOIL fulfilled or denied; J /
Closed by:
Date:
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Amount Due: --, Pages for a total of $ `°~®
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00, requesting that the records
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Telephone • FAX #: ( ) -
Email address: h'C A gT 66 r` 1
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
I request 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
listed
I request that the records be sent via e-mail to the address above
I request that the records be faxed to the number listed above