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Forms Can Be Submitted via Email to l�ncconologue(a?to nofwappingerny.gov- or
r•obinson c townofwai r?Y or in person/via snail to 2.0 Middlebush. Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni Town
Lori McConologue I
Grace Robinson
Date Received: /
TOIL Ser. ##:
DEPARTMENT:
ASSESSOR
ACCOUNTING
❑
CODE ENFORCEMENT
HIGHWAY
❑
RECEI.VI=,R OF TAXES
El
RECREATION
SUPERVISOR.
El
TOWN CLERK
WATER/SEWER
DOG CONTROL OFFICER ❑
TOWN ENGINEER
TOWN ATTORNEY
❑
"" OF WAPPINGER
Application for Public Access to Records
an Clerk
gilding Departrrt r°rt
IVVN OFWAPPINGt::.'
FOR DEPARTMENT USE ONLY
Date Received by :Dept
Department Head approval:
(init)
Date Applicant Contactcdl t 1 12,5
Date FOIL fulfilled or denied: f / / Z
Closed by:
Date:
Notes:
Amount Due: Cages for a tal of $
r Name: 4 t` i <. 1 ` � _... ❑check here if you are
Address: ,... requesting that the records
,J be mailed to this address.
Agency or firm:
Telephone 4: (ed ejj � � �� � FAX #:
y
.. Email address: i�')A 4:," _ 41Ai� ��
DESCRIPT ON OF RECORdDd:
b 22-1 1 a 9 J) t"') V •. ( �
FORMAT OF RECORD (if available) J / 6V 7510
I request to be notified when I can come to inspect the record(s) described above
r 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 c-niail to the address listed above
I request that the records be faxed to the number listed above