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Forms Can Be Submitted via Email to lxncconolIogue(c townofvvappiri erny. txv or
grobinson(iU'townofwa in 7err1 ov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseplh. P. Paoloni —
Leri McConologue
Grace Robinson I
Date Received:
FOIL Ser'. #: ` .7 --
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
CODE ENFORCEMENT
Z
HIGHWAY
❑
RECEIVER OF TAXES
❑
RECREATION
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SUPERVISOR
❑
TOWN CLERK
❑
WATER/SEWER
❑
DOG CONTROL OFFICER ❑
TOWN ENGINEER.
TOWN ATTORNEY
TOWN OF WAP'PINGER
Application for Public Access to records
ILREOUEST
,a
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department head approval:
init)
Date Applicant Contacted: I / e( / L-(
Date FOIL fulfilled or denied:
Closed by
Date: / y /
Notes: Cq - cr 5e G,,_ Ah,
Amount Due: __I__ Pages for a total of $ Z5�
Name:&❑check here if you are
Address: c kS\, requesting that the records
[A A 1 " be mailed to this address.
Agency or firm: a
Telephone #: " t I) ` -D FAX #: ( ) -
Email address: t r. \,4 c) vv -ti -_ � t% YY U), --
SPECIFIC D CRIPTION OF RKORD:
7
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
E]i 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