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Forms Can Be Submitted via Eniail to In11qcQnol,ogq W1 11 ow rofwappingerny.gov car
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FOR INTERNAL,U„ E,QCIL"r'
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Received by: Joseph P. Paolonr
Lori McConologuc 1
Grace Robinson I
Date Received: I.....m.... I
FOIL, Scar. #:
DEPARTMF:NT:
ASSESSOR
ACCOUNTING
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CODE ENFORCEMENT
HIGHWAY
RECE1VEI1 OF FAXES
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SUPERVISOR
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TOWN CLERK
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WATER/SHWER
DOG CONT OFFICER
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TOWN ENGINEER
TOWN ATTORNEY
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Address:
Agency or firm:
Telephone #: (/[
Email address: P_N_
TOWN OF WAPPINGER
Application for Public Access to records
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FOR DEPAI�.TMENT USE ONLY
Date Received by Dept !/ C
Department Head approval:
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Date Applicant Contacted: 1rj. IAI J
Date FOlfulfilled pr denied: Id 9/
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Closed by:
Date:
Notes: em
Amount Due: _.._..... ._.._ Pages for a total of $
Dchcck here if you are
? requesting that the records
C d fi r be nailed to this address.
FAX #: ( _�
SPECIFIC, DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available) - C./
H1request to be notified when I can come to inspect the record(s) described above
I request copies of the records described abo.;ve and agree to pay the cost of such records in
accordance with the fee schedule on the back of this application
l request that the records be sent via e-mail to the address listed above
0 I request that the records be faxed% to the number listed above