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Forms Can Be Submitted via Email to lrncconolOgLIC c townofwappijigerny.gov or
grobinson(c-r,townofwappingerny.gov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12510
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FOR INTERNAL USE ONLY i
Received by: Joseph P. Paoloni o W ri
Lori McConologue -1 "°
Grace Robinson F
Date Received: /
FOIL Ser. #:
DEPA RTMENT:
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2025TOWN OF WAPPIl` GER
Application for Public Access to Records
Ppinger
FOR DEPARTMENT USE ONLY
Date Received by Dept /Wit
Department Head approval:
Date Applicant Contacted: I / /
Date FOIL fulElied or denied: 1
Closed by:
Date: _L/ /
Notes: evw UiA
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Amount Due: Pages for a total of
Name: ❑check here if you are
Address: r requesting that the records
be mailed to this address.
Agency or firm: r
lehone #: � AX #:
Emeal paddress: ot o ,
SPECIFIC DESCRIPTION 0 RECORD:
FORMAT OF RECORD (if available)
I request to be notified when I 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