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Forrns Can Be Submitted via Email to lrncconologuc(Otownohvappizi eniy, ,ov or
grobinsonCc�townof vappiiigerny,gov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni A
Lori McConologue
Grace Robinson Cl
Date Received: / 1
FMC. Ser. ##:
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
❑
CODE ENFORCEMENT
HIGHWAY
RECEIVER OF TABES
RECREATION
❑
SUPERVISOR
❑
TOWN CLERIC
❑
WATER/SEWER
❑
DOG CONTROL OFFICER El
TOWN ENGINEER
TOWN ATTORNEY
TOWN OF WAPPINGER
Application for Public Access to Records
eceivea FOIL
tie
own n 4 V
0V ox I.
Whig Departrn It
1N OF WAPPINGER
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval
Date Applicant Contacted:
Date FOI il�Itd denied
Closed by:
Date:
Notes: j
Amount Due : Pages for a total of $—LCD
Name:
�,�,��� !r'-y�Y� "t.� :,, []cheek here if you are
Address: requesting that the records
i g 6 be mailed to this address.
Agency or firm:
Telephone #: ( - FAX ##:
Email address:
SPECC DESCRIPTION OF RECORD
17
FORMAT OF RECORD (if available) m M ] -73
HIrequest to be notified when I can cornu 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