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Forms Can Be Submitted via Email to ImcconologuaeL(btownofwa. pingerny. ov or
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grobinsonCer,towtrofwappirtgerny.gov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph. P. Paoloni I9
Lori McConologue
Grace Robinson
Date Received:
FOIL Ser. #: �+
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
HIGHWAY
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RECEIVER OF TAXES
El
RECREATION
❑
SUPERVISOR
❑
TOWN CLERK
❑
WATER/SEWER
❑
DOG CONTROL OFFICER
TOWN ENGINEER
TOWN ATTORNEY
Application for Public Access to Records
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FOR DEPARTMENT USE ONLY
Date Received by Dept /
Department Head approval:
i.
Date Applicant Contacted: / �6/
Date FOIL fulfilled or denied: / J
Closed by:
Date: t4 /30/
Notes:
Amount Due: — Pages for a total of
Narne: �'d_,,' ` � [check here if you are
Address:y requesting that the records
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Agency or firm: I/ zJ
Telephone ##: ('" - FAX #: ( } -
Email address: rc.. Aw- t:F ; a err a i wC.Z,k
SPECIFIC DESCRIPTION OF RECOI;�D- p
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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
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