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Forms Can Be Submitted via Email to linccoii4loy4tloOA�,*6fwappingerny.go or
grobiiisoiiLa)towtioN4.p�iiigci-ny,gov or in person/via snail to 20 Middlebush Rd Wappingers Falls, NY 12590
,JAN 3 0 ?0?5
FOR INTERNAL USETBUM'' i fTEOIAN OF WAPPINGER
Application for Public Access to Records
Received by: Joseph P. Paoloni I
RE UEST
Lori MCC011010gLIC
Grace Robinson
Date Received:
FOIL Ser. 4:
_Ok-09�_
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEM FNT
E]
HIGHWAY
1:1
RECEIVER MJF TAXES
El
RECREATION
SUPERVISOR
❑
TOWN CLERK
❑
WATER/SEWER
DOG CONTROL OFFICER ❑
TOWN ENGINEER
TOWN ATTORNEY
, p
eutld'l0goe
FOR DEPARTMENT USE ONLY
Date Rcccivcd by Dept
Department [lead approval:
Date Applicant Contacted:
Date F( ed 4 denied:
Closed by:
Date:
Notes:
U
Amount Due: Pages for a total of$
Ocheck here if you are
Address: LL,ktc
requesting that the records
j'j_o� rN be nailed to this address.
Agency or farm:
Email address:
LA6,
SPECIFIC DESCRIPTION OF RECORD:
FOR_MAT OF IZECORD (if available)& j / I � -) C), - %
HI reqnest, to be notified when I can conic to inspect the record(s) described above request copies of the records described above and agree to pay the cost of sucl- records in
accordance with the fee schedule on the back of this application
Elt request that the records be sent via e-mail to the address listed above
1:1 1 request that the records be faxed to the number listed above