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Forms Can Be Submitted via. Email to lmeconologLaeLbtownofwappingerny. ov or
gcobinson a townofwapingern. ov or in person/via mail to 20 Middlebush Rd. Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni E
Lori McC:onologue
Chace Robinson E
Date Received: 1 /
FOIL Ser. #: r'� l � d
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
CODE ENFORCEMENT
HIGHWAY
RECEIVER OF TAXES
0
RECREATION
❑
SUPERVISOR
1:1
TOWN CLERK
0
WATER/SEWER
7
DOG CONTROL OFFICER
TOWN ENGINEER
TOWN ATTORNEY
7
TOWN OF WAPPI GER
P,ce'NA41ication for Public .Access to Records
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FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept _ /p
Department Head approval:
(init)
Date Applicant Contacted:/ /
Date FOI fulfilled o denied: f
Closed by:
Date: / l
Amount Due: Pages fora total of §
Name: O CA E]check here if you are
Address: _ Ml? - eft r✓CIL -- requesting that the records.
WbI* ,_ N1 I DLV' be mailed to this address.
Agency or firm:
Telephone #: (c l Ll FAX #: ( ) -
Email address: WWI U -9" C' CO /-Y
SPECIFIC DESCRIPTION OF RECORD:
FORMAT OF RECORD (if available)
I request to be notified when I can corne 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
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