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Forms Can Be Submitted via Email to Imcconologue(a�,townofwappingerny.gov or
grobinsong,townofwappingerny.gov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
Received
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni
Lori McConologue Town
Grace Robinson ❑
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
❑
CODE ENFORCEMENT
'jZ1,
HIGHWAY
❑
RECEIVER OF TAXES
❑
RECREATION
❑
SUPERVISOR
❑
TOWN CLERK
❑
WATER/SEWER
❑
DOG CONTROL OFFICER ❑
TOWN ENGINEER
❑
TOWN ATTORNEY
❑
AN 2 8 20T OWN OF WAPPTNGER
Application for Public Access to Records
f W a p p w n g E'oIL .REQ UEST
an Clerk _
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
(init)
Date Applicant Contacted: ) 1 y91
Date FOIL fulfilled or denied:
Closed by:
Date:�-
Notes:
Amount Due: Pages for a total
Name: - , y` `L check here if you are
Address: fie. 6 �� requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: j) AX #: { )
Email address: C i r in.r�6 D) q Gt k.L%,-- C U` -v-`
SPECIFIC DESCRIPTION OF CORD: �—
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