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Forms Can Be Submitted via Email to lmcconologue cr,townof�va in >ern xov or
gr°obinson(iD,town oftvappingern.y.g;ov or in person/via mail t 20 Middlebush Rd Wappingers Falls, NY 12590
ReceV,
FOR INTERNAL USE ONLY OA`s
Received by: Joseph P. Paolon�i° of
Lori McConologlu
Grace Robinson
Date. Received: / 1
FOIL Ser. #:
DEPARTMENT
ASSESSOR
❑
ACCOUNTING
❑
CODE ENFORCEMENT
HIGHWAY
❑
RECEIVER OF TAXES
RECREATION
SUPERVISOR
❑
TOWN CLERK
WATER/SEWER
C]
DOG CONTROL OFFICER []
TOWN ENGINEER
TOWN ATTORNEY
Name:
Address:
Agency or Erni:`.,
Telephone
Email address:
VZ4 TOWN OF WAPPINGER
,,.W.NWation forPublic
�W
'
FOR DEPARTMENT USE ONLY
Date Received by Dept 1
Department Head approval:
Date Applicant Contacted: a/,S/jxd
Date FO
(L::f:UTe? or denied.
Closed by:
Date:
b
Notes:,
Amount Due.: Pages for a total of $
�'�check here if you are
c — requesting that the records
b be mailed to this address.
FAX #: (
SPECIFIC DES�RTPTTON O RECO
i , _ Y I'k
FORMAT OF RECORD (if available) �O. a 3 -- 4
I request to be notified when I can come to inspect the rccord(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