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Forms Can Be Submitted via Email to linceonologueLc towti afwappiiigerliy.gov or
robinson cc,townofwa in ei-n ov 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: f J
FOIL 'Ser. #: noa" — "
DEPARTMENT:
ASSESSOR
Date Received by Deptl�'
ACCOUNTING
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CODE ENFORCEMENT
Date Applicant Contacted:
HIGHWAY
Date FOIL fulfilled or denied:
RECEIVER OF TAXES
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RECREATION
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SUPERVISOR
TOWN CLERIC
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WATER/SEWER
DOCS CONTROL OFFICER
TOWN ENGINEER
TOWN ATTORNEY
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Name:
Address:
Agency or firm:
Telephone #:
Email address:
Applkption for Public Access to Records
FML REO UFST
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FOR DEPARTMENT USE ONLY
Date Received by Deptl�'
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Department
Department Head approval:
( 1
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Date Applicant Contacted:
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Date FOIL fulfilled or denied:
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Closed by:
Date:
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Amount Due: Pages for a total of _ 7.96
-� FAX #: ( )
® check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
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