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Forms Can Be Submitted via Email to Irncc011010gUe0ctownolwappingcrny.gov or
robinson cvtownofwa in ern . ov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni
Lori McConologue
Grace Robinson C
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
El
ACCOUNTING
❑
CODE ENFORCEMENT
141011WAY
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RECEIVER OF TAXES
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RECREATION
I request copies of the records described above and agree to pay the cost of such records in
SUPERVISOR
O
TOWN CLERK
El
WATERJSEWER
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DOG CONTROL. OFFICER ❑
TOWN ENGINEER
❑
TOWN ATTORNEY
TOWN OF WAPPINGER
Application for public Access to Records
r IREQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept ® / /,2-Y
Department Head approval:
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Date Applicant Contacted: 11171QLJ
Date FOIL fulfilled or denied: / /
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Closed by: &Zzot_14_ __1
Date:
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Notes: nexin;ded
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Arnount Due: — Pages fora total of $
Name: E] heck here if you are
Address: requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: ( 3 "�
- —,FAX )
Email address:
SPECIFIC DESCRIPTION OF RECORD Ac
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FORMAT OF RECORD (if available)
Irequest 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