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Forms Can Be Submitted via Email tolmcconologuc(&,townofwappMgeri . ov or
robinson ?�,townofwa in errs . 7ov or in person/via snail to 20 Nliddlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paolom 1
Lori i' 1!IcConologue
Grace Robinson I'.--
Date
:
Date Received: / _ /
FOIL Ser. 9: 0 )-4 a- 30-3
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
QP
HIGHWAY
❑
RECEIVER OF TAXES
FORMAT OF RECORD (if available)
RECREATION
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SUPERVISOR
❑
TOWN CLERK
❑
WATER/SEER
❑
DOG CONTROL OFFICER
TOWN ENGINEER
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TOWN ATTORNEY
❑
Name:
Address:
TOWN OF WAPPMGER
Application for Public Access to Records
6 FOIL REO
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Date Received by Dept Willi, Department Head approval:
Date Applicant Contacted: / l
Date FOI <furl lled r denied: / /f/
Closed by:
Date:
Il '
Notes:,
Amount Due: Pages for a total of
Agency or firm: IN
"Telephone ##;",�)- , FAQ"
Email address:
®check here if you are
requesting that the records
be mailed to this address.
DESCRIPTIONSPECIFIC OF RECORD:
_6 IT11—h
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
Irequest 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