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Forms Can Be Submitted via Email to lodell( townofwappin germ og_v or in person/via mail to 20 Middlebush
Rd Wappingers Falls, NY 12590
®r-11 W153 W61MWA
Received by: Joseph P. Paoloni ]
Lynn. O'Dell L�
Lori McC011010gUC
Date Received: l / down o
FOIL Ser. #: TCS'
DEPARTMENT:
ASSESSOR
ACCOUNTING
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CODE ENFORCEMENT
PLANNING
C
ZONING
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FIRE INSPECTOR
HIGHWAY
RECEIVER OF TAXES
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RECREATION
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SUPERVISOR
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TOWN CLERK
FI
WATER/SEWER
L1
DOG CONTROL OFFICER
11-1
TOWN ENGINEER
❑
TOWN ATTORNEY
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Name:
Address: ...
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Builftg Department
FOR DEPARTMENT USE ONLY
Date Received by Dept 7
Department Head approval:
(mit)
Date Applicant Contacted: / /
Date FOIL fulfilled or denied: / 9 /t'
Closed by: ✓ .
Date:
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Notes: ewe, jQ veo
Amount Due: _Z-_ Pages for a total of $5
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requesting that the records
be mailed to this address.
Agency or firm.:
Telephone : FAX #:
Email address:
SPECIFIC DESCRIPTION F REC RD:
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FORMAT OF RECORD (if available)
L , l request to be notified when I can come to inspect the record(s) described above
L✓/ 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
rL 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