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Forms Can Be Submitted via Email to Imcconolog ue cutownofwa in cern . tov or
grobinson((b,townofwappingerny.gov or in per on/via mail t 20 Middlebush Rd Wappingers Falls, NY 125911
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FOR INTERNAL USE ONLY ,wx'
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Received by: Joseph. P. Paoloni I
Lori McConologue 1 I w n
Grace Robinson J
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
ACCOUNTING
FORMAT OF RECORD (if available)
CODE ENFORCEMENT
I request copies of the records described above and agree to pay the cast 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
IIIGHWAY
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RECEIVER OF TAXES
RECREATION
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SUPERVISOR
❑
TOWN CLERK:
❑
WATER/SEWER
DOG CONTROL OFFICER ❑
TOWN ENGINEER
❑
TOWN ATTORNEY
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FOR DEPARTMENT USE ONLY
Date Received by Dept / �
Department Head approval:
Date Applicant Contacted: I /
Date FOI fulfilled' denied: / /)
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Closed by:
Date: y / 301
Notes:
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Amount Due: Pages for a total of $
Name: (2-f 2
LCE 7i'fb Rcheck here if you are
Address: VC) -ice e requesting that the records
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Agency or fii-rn:
Telephone #: FAX#: ( )
Email address: t. le -A - 6) n
SPECIFIC DESCRIPTION OF RECORD:
FORMAT OF RECORD (if available)
IHrequest 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 cast 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