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Forms Can Be Submitted via Email to lrncconologrie(a)towWnofwvapd)ingerny.gov or
grobinsoni�tor in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni ❑
Lori McConologue w
Grace Robinson E
-
Date Received:. l /
FOIL Ser. #: r�
DEPARTMEN'T':
ASSESSOR
❑
ACCOUNTING
CODE ENFORCEMENT
I-IIGH WAY
RECEIVER OF TAXES
❑
RECREATION
SUPERVISOR]
TOWN CLERK
❑
WATER/SEWER
❑
DOG CON,rROL OFFICER
❑
TOWN ENGINEER
❑
TOWN ATTORNEY
❑
TOWN OF WAF PINGER
Application for Public Access to Records
NOV 1,9 ?024
1 t ' . . Building Department
.. � r`�\?J n � . TOWN OF WAPF' El
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval.:
(lnit)
Date Applicant Contacted: f _ f..
Date FOIL fulfilled or denied: 1 f
Closed by:
Date: r( / if
Notes:
Amount Due: Pages for a total of S
_ ❑check here if you are
Address: ( ess: i `% �requesting that the records
( P be mailed to this address.
Agency or film:
Telephone #: (`, _ FAX #: VEmail address: cC)
s' .._._...
SPECIFIC "',SCRIPTION OF RECORD:
F' RNIAT OF RECORD (if available)
I request to be notified when 1 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