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Forms Can Be Submitted via Ernail to Imcconologue(townofwappingerny.gov or
grol)il•rson_1btov1nofwa iinngern Fav or in person/via snail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph. P. Paoloni
Lori McConologue 4��
Grace Robinson i
Date Received: / I
FOIL Sera. #:
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
❑
CODE ENFORCEMENT
❑'
HIGHWAY
❑
RECEIVER OF TAXES
❑
RECREATION
Ll
SUPERVISOR
TOWN CLERIC
❑
WATER. /SEWER
❑
DOG CONTROL OFFICER ❑
TOWN ENGINEER
TOWN ATTORNEY
TOWN OF WAPPINGER
A ication for PUbl.ic Aess to Records
FOIL ISE � � a r
FOR DEPAR'mlMEN'l" USE, ONLY
Date Received by Dept 1"'911 1
Department Head approval:
rt)
Date Applicant Contacted: Id /I-:)
Date FOI ilfilled r dcrlied:
Closed by:
Date: /.,
Notcs: `
Amount Due: _ Pages for a total of
Name: "'� 1 al ❑check here if you are
Address: Al- &n (A � 4� requesting that the records
be mailed to this address.
Agency or firm.: �� ✓�'`�?a �:a�i'
Telephone ##: ( wt j ) q �i, _ - a. j FAX #t
Email address: ,�, f ., r , „✓?
SPECIFIC DESCRIPTION OF RECORD:
_..
FORMAT OF RECORD (if available) /�
IH
request to be notified when I can come to inspect the record(s) described above
1 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
F-] request that the records be faxed to the number listed above