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Forms Can Be Submitted via Email to lmcconolo17Lie Letowiiofwapp ingerny. go or
robinsoii� townofwa a n fern . ov or in persoi-ilvia mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni
Lori McConologue
Grace Robinson I
TOWN OF W t PPI
Application for Public Access to Records
FOIL RE LTJ�
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FOR DEPARTMENT USE ONLY
Date Received:I /
FOIL Ser. #: 9b _4 — 3 d-
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DEPARTMENT:
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ASSESSOR ❑
ACCOUNTING Elf
CODE ENFORCEMENT
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RECEIVER OF TAXES
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RECREATION
SUPERVISOR ❑
TOWN CLERK C
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WATERJSEWE,R ❑
DOG CONTROL OFFICERT ❑
TOWN ENGINEER Q
TOWN ATTORNEY Q
TOWN OF W t PPI
Application for Public Access to Records
FOIL RE LTJ�
E W E,
FOR DEPARTMENT USE ONLY
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Date Received by Dept
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Department Head approval:
Date Applicant Contacted:
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Hate FOIL, fulfilled or denied:
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Closed by:
Date:
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Amount Due: --Pages for a total of $
Name: °` f, E] check here if you are
Address:'R requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: ( /) `° - 5" 7 FAX -
Email address: I /
SPECIFIC DESCRIPTION OF RECORD:
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
I request that the records be sent via e-mail to the address lusted above
I request that the records be faxed to the number listed above