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Forms Can Be Submitted via Entail to lmccotiologue(iDtownofwappingerny.g,ov or
robinson c6townofwa in -,cm ov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni 1'
Lori McConologue
Grace Robinson F
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
El
ACCOUNTING
CGDE ENFORCEMENT
HIGHWAY
RECEIVER OF TAXES
El
RECREATION
SUPERVISOR
TOWN CLERK.
El
W ATER/SEWER
DOG CONTROL OFFICER
0
TOWN ENGINEER
TOWN ATTORNEY
El
TOWN OF WAPPIN E ..
Application for Public Access to Records
FOIL REOU ST°
a� F
\ u a A
FOR DEPARTMENT USE ONLY
Date Received by Dept. / /,
Department Head approval:
(init)
Date Applicant. Contacted: / /a / ,, , I
Date FOIL fulfilled or denied:
Closed by:� C
r,
Date:
Notes;
Amount Due:. Pages for a total of S
Nance: t check here if you are
Address: LO requesting that the records
/ "', . ; CIL? be mailed to this address. L� ell
Agency or firm:
Telephone ##: (;i i ) ti - 2,2_- FAX
Email address:tem'
SP m'CIFIC DESCRIP ION OF R OD .D.
jo
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
0 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