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Forms Can Be Submitted via. Email to lmcconologue(�,townof��� or
robinson c�townofNNra in Tern Dov or in person/via snail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paolom
Lori. McConologue -1
Grace Robinson
Town
Date Received: /
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
HIGHWAY
❑''
RECEIVER OF TAXES
❑
RECREATION
SUPERVISOR
TOWN CLERK
WATER/SEWER
❑
DOG CONTROL OFFICER ❑
TOWN ENGINEER
0
TOWN ATTORNEY
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JOWNOF W.APPIN ER
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%%plication for Public .Access to Records
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FOR DEPARTMENT USE ONLY
Date Received by Dept
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Department Head approval:'
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Date Applicant. Contacted:
Date F IL fulfilled r denied: I l
Closed by: %
Date;
Notes:
Amount Due: Pages for a total of s / ,
Narne: r` 6A f'" ®check here if you are
Address: 1 C requesting that the records
O , ' be mailed to this address.
Agency or firm: \
Telephone #: FAX #: ( )
Email address:'. q t C G
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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
❑ 1 request that the records be sent via e-mail to the address listed above
EjI request that the records be faxed to the number listed above