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Forms Can Be Submitted via Email to li-nccollologLIC�towiiofwall)piLiny gov or
. robiiisoiiC&,towiiofwappiiigorny.gov or in person/via mail to 20 Midd[ebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni 1
Lori MCC011010gUe
Grace Robinson 7
Date Received:
FOIL Ser. 9:
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
0_
HIGHWAYD
RECEI\/ER OF TAXES
El
RECREATION
El
SUPERVISOR
F�
TOWN CLERK
El
WATER/SEWER
DOG CONTROL OFFICER
TOWN ENGINEER,
TOWN ATTORNEY
E]
'rowN OF WAPPINGER
Application for Public Access to Records
FOIL R ST
N
ill uji'ding Departniant
OVM OF WApprl\lrr
FOR DEPARTMENT USE ONLT-----d--
Date Received by Dept
Depart.nient Head approval
Date Applicant Contacted'.
Date FOIfillf 1ICd � denied
(nfiih,-�
Closed by:
Date:
Notes: Cipo az&
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/ - /) -.') / -
Amount Due: '7 Pages for a total of $—L.IrL
Name: A\ [l check here if you are
Address: -D, kl' at requesting that the records
be mailed to this address.
Agency or firm:_
Telephone #: ,/) y y5.5 5'- FAX 4:
Email address: ---o
SPECIFIC DESCRIPTION OF RECORD: co –12co-q— a)
FORMAT OF RECORD (if available) br 3,Sq -Of 1-6060�.)
I request to be notified when I can come to inspect the record(s) described above
I request copies oftlic records described above and agree to pay the cost of such records'0,
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
.1. request that the records be taxed to the number listed above