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Forms Can Be Submitted via. Email to lmcconolo���e�cvto vnof�vap iti Qerny.gov or
;robinson ,totivnofwapin crny°. 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:
FOIL Ser. #:-
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
❑
CODE ENFORCEMENT
HIGHWAY
RECEIVER OF TAXES
❑
RECREATION
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SUPERVISOR
❑
TOWN CLERK.
❑
WATER/SEWER
DOC! CONTROL OFFICER ❑
TOWN ENGINEER
TOWN ATTORNEY
❑
.° 0
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR D; P�
� h
Date Received by Dept
Department Head approval:
(In -it)
Daae Applicant. Contacted: a / % l '
Date FOIL bfifillecl or denied: l 7-1-3-)
i
Closed by:
Date: l 1
Notes:Ak::fw...
Amount Due: Pages for a total of
Name: ❑ check here if you are
Address: k requesting that the records
be mailed to this address.
Agency or firm: v
Telephone : ( A : ( ) -
Email address: �--
SPECIFIC DESCRIPTIO OF RECORD:
ON ' \ ,'
FORMAT OF RECORD (if available)
IH
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