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Farms Can Be Submitted via. Email to lIII cconolo�araeL1)townofwa in ern . rov or
S .hinsonlcr town-l=iilgcrny.gov or in per i 20 vliddlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
"'Fown of
Received by: Joseph P. Paoloni
Lori MCConolague town
Grace Robinson r°
Date Received: / /
FOIL Ser. #: ZZ5 1
DEPARTMENT:
ASSESSOR
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ACCOUNTING
E,
CODE ENFORCEMENT
HIGHWAY
RECEIVER OF TAXES
El
RECREATION
[,
SUPERVISOR
CI
TOWN CLERK
WATER/`S EWER
❑
DOUG CONTROL OFFICER
❑
TOWN ENGINEER
❑
TOWN ATTORNEY
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Name:
Address:
Agency or firm:_
Telephone #:
Email address:
O rAftrication for Public access to Records
9e k FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Deceived by Dept l l /I I
Department Head approval: _
(init)
Date Applicant Contacted: LL / / -2—
Date FOIL fulfilled or denied: / l
Closed by:
Date: / 1
Nates:
Amount Due: Pages for a total of $
) ;_ .,� I - /S . `.,? FAX #: (
®check here if you are
requesting that the records
T?,S ` be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
F
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
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