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Forms Can Be Submitted via Email to lmcconotogLie(i to tiofwa pirigern r.gov or
grobinson c—([ownol-%yappin erny.gov or in p' "'m , 044.'ti ' to 20 Middlebush Rd Wappingers Falls, NY 12590
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FOR INTERNAL USE ONLY
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Received by: Joseph P. Paoloni ° "0+ i rl
Lori McConologue
Grace Robinson 0 ri
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
HIGHWAY
RECEIVER OF TAXES
RECREATION
SUPERVISOR
TOWN CLERK
IN
DOG CONTROL OFFICER Fj
TOWN ENGINEER Q
TOWN ATTORNEY �]
Application %t' Public Access to records
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FOR DEPARTMENT USE ONLY
Date Received by Dept l
Department Head approval;
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Date Applicant Contacted: I&
Date FOIfulfrlled denied:
Amount Due: Pages for a total of $
Name: �i . . �°,�-. ,> []check here if you are
Address: 3 requesting that the records
/ ,U t `. . / i°µ3 " be mailed to this address.
Agency or Firm:
Telephone #: :z.., . FAX #: { )
Email address: _�rao c�c4j =--
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available) 1
I request to be notified when I can Borne to inspect the record(s) described above
l 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