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Forms Can Be Submitted via Email to lmeconol.ogue c,townofwa in ern . ov or
grobins ongtownofwappingerny.gov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni ❑
Lori McConologue
Grace Robinson ❑
Date Received: 1 1
FOIL Ser. #: "
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
❑
CODE ENFORCEMENT
HIGHWAY
❑
RECEIVER OF TAXES
❑
RECREATION
❑
SUPERVISOR
❑
TOWN CLERK
❑
WATER/SEWER
❑
DOG CONTROL OFFICER
❑
TOWN ENGINEER
❑
TOWN ATTORNEY
❑
Name;
Address:
. TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
,ceived
11, Z05
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Date Received by Dept .rX_,. /I I 1
Department Head approval:
(init)
Date Applicant Contacted: 2=— 1 t [ 12..
Date FOIL fulfilled or denied: �0 1
Closed by:
Date: 1 [(1
Notes: 'DO V ' "'� .Aj
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Amount Due: Pages for a total of
®check here if you are
requesting that the records
be mailed to this address.
Agency or fin -n:
Telephone #:�r�- )i 'j�'" FAX #: (i -
Email address: _= � ., r � .a r,�:pybL C).1 \ \�,,...
SPECIFIC DESCRIPTION OF RECORD:_
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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