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Forms Can Be Submitted via Email to lmcconolOgLieL�townofwa yin eri ov or
grobinson irltowiiofwa in ern ov or in person/via mail to 20 Micldlcbush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by Joseph P. Paoloni
Lori McConologue
Grace Robinson. C
Date Received: / J
FOIL Ser. #: .�
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
❑
CODE ENFORCEMENT
HIGHWAY
❑
RECEIVER OF TAXES
7
RECREATION
El
SUPERVISOR
❑
TOWN CLERK
❑
WATER/SEWER
❑
DOG CONTROL OFFICER ❑
TOWN ENGINEER.
❑
TOWN ATTORNEY
❑
1. S 4 ` 1 0
FOR DEPARTMENT USE ONLY
Date Received by Dept / ;
Department Head approval:
Date Applicant Contacted: / I /jG9
Date FOIL ulfilled or denied: J J
Closed by:
Date:
Notes:'
Amount Due: Pages for a total of $
Name:
❑check here if you are
Address: WilC requesting; that the records
A. be mailed to this address.
Agency or firm: z
Telephone #: FAX #: }
Email address:
SPECIFIC DESCRIPTION OF RECORD:
tz
FORMAT OF RECORD (if available) -L-,
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