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Forms Can Be Submitted via Email to lmeconolOgLie(c�,townofwappingeraay.gov or
grobinson(c-()townofwapping2fay,go or in person/via mail to 217 Middlebush Rd. Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni
Lori McConologue
Grace Robinson F
Date Received: / f
FOIL'. Ser. :
DEPARTMENT:
ASSESSOR
El
ACCOUNTING
0
CODE ENFORCEMENT
HIGHWAY
F '
RECEIVER OF TAXES
❑
RECREATION
11
SUPERVISOR
❑
TOWN CLERK
❑
WATER/SEWER
❑
DOG CONTROL OFFICER ❑
TOWN ENGINEER
[�
TOWN ATTORNEY
❑
TOWN OF WAPPINGER
Application for Publi cess to records
ReceivedFoIj
FOR DEPARTMENT USE ONLY
Date Received by Dept /
Department Mead approval:
Date Applicant Contacted: 5 I 121
Date FOIL fulfilled or denied: 45 / Lq /
Closed by:.
VAZ�'
Date:® / /
Notes:JO—PVJ' 11✓"h i"
Amount Due: —Pages far a total of $_
Name: ° check here if you are
Address: requesting that the records
WAN forLL3 be mailed to this address.
Agency or firm: I
Telephone #: { FAX #: { ) -
Email address:
SPECIFIC DMIPTION OF R '
247 DRQ-
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