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Forms Can Be Submitted via. Email to liucconoloLLie �`townofwa . pir1 Bern . ov or
robinson c townofwa in germ . rov or cif ' r��� 6 a�20 Middlebush. Rd Wappingers Falls, NY 12590
MAY 13 0?5
FOR INTERNAIr-DISE N Y �>
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Received by: Joseph P. Paoloi i(; W l C'I I:.
Lori McConologue
Grace Robinson (.
Date Received: I I
FOIL Ser. :
DEPARTMENT:
ASSESSOR
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ACCOUNTING
0
CODE ENFORCEMENT
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HIGHWAY
RECEIVER OF TAXES
RECREATION
FORMAT OF RECORD (if available)
SUPERVISOR
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TOWN CLERK
1:1
DOG CONTROL OFFICER
TOWN ENGINEER El
TOWN ATTORNEY
U104 licauls
MAY 0 5 2025
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FOR DEPARTMENT USE ONLY
Date Received by Dept15 1
Department Head approval; Cj.
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Date Applicant Contacted:
Date FOIL fulfilled or denied: l f I'; "s
Closed by:
Date:
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Notes: t t o I r� In CLi t
Amount Due: Pages for a total of ,$
Name: QvF 1— check here if you are
Address: 2_requesting that the records
be mailed to this address.
Agency or firm:
Telephone ( FAX #: ) -
Email address:—hi b e)
SPECIFIC DESCRIPTION OF RECORD:
.�o S UqF;''' �
FORMAT OF RECORD (if available)
HIrequest
to be notified when I can came 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
❑
0
accordance with the fee schedule on the back of this application
1 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