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Forms Can Be Submitted via Email to Imcconolo �deCci townof rappingerny gov or
grobinsonCCtownofwa i I cgi gov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR. INTERNAL USE ONLY eceivefOWNOF WAPPINGER
Alicatiort for Public Access to Records
Received by: Joseph P. Paoloni 1 ISR 5 2005 FOIL RE
Lori McConologue�of�
Grace Robinson I ( E f 1` �� � Eri E l J
Town Clerk
Date Received: I /
FOIL Ser. #l: r —%�. �47'
BOding Department
Town of Wappinger
DEPARTMENT:
ASSESSOR 0 FOR DEPARTMENT USE ONLY
ACCOUNTING ❑ �
CODE ENFORCEMENT Date Received by Dept l 1 f
HIGHWAY Department Head approval:
RECEIVER OF TAXES El
RECREATION ❑ Date Applicant Contacted: 1 l
SUPERVISOR 1:1 _.
TOWN CLERK. Date FOIfulfilledo denied: /
WATERfSEWER 1:1
DOG CONTROL OFFICER Q
Closed by:
TOWN ENGINEER ❑ Date: 1 1
TOWN ATTORNEY ❑
t
Notes:
Amount Due: Pages for a total of $
Name: Ocheck here if you are
Address:zz2f requesting that the records
be mailed to this address.
Agency or firm::)i11
Telephone #: ) `. r FAX #: ( }
Email address:
SPECIFIC DES IP ION OF = CO
FORMAT OF RECORD (if available) I `317J-1co
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 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