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Forms Can Be Submitted via Email to ImcconologueL6townofwapl)in�yerny.gov or
grobinson cc town ofwappin en y. ow or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
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FOR rNTERNAL USE ONLY
Received by: Joseph P. Paolom '_1 TO
Lori McConologue C11
Grace Robinson r_1
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR EIZ
ACCOUNTING F71
CODE ENFORCEMENT
HIGHWAY
RECEIVER OF TAXES E3/
RECREATION E]
SUPERVISOR
TOWN CLERK
WATER/SEWER
DOG CONTROL OFFICER
TOWN ENGINEER
TOWN ATTORNEY
Name: EJAZ
Address: 'u�
MAR % WAPPfNGER
�k?l for Public Access to Records
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FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
(init)
Date Applicant Contacted:
Date FOIL fulfilled or denied
Closed by:
Date:
Notes: /00 JN' F69.PnR11AA( 14OL4e
Amount Due: Pages for a total of $
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requesting that the records
_CCA y6 � N lqlsqo be mailed to this address.
Agency or firm:
Telephone 4: FAX #:
Email address:
CID ECIFIC DESCRIPTION OF RECORD:
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FOR T OF RECORD (if available)
I request to be notified when I can come to inspect the record(s) described above
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
EjI request that the records be faxed to the number listed above