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Forms Can Be Submitted via, Email to lmcconolo icCfc fownofwappin ern y. )ov or
rc binso a�townofNvap2LnLerny.gcov or in person/via mail to 20 luliddlebush Rd Wappingers Falls, DIY 12590
FOR. INTERNAL USE ONLY
Received by: Joseph P. Paoloni N
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Grace Robinson 0
Date Received; /
FOIL Ser. #:' - 133
DEPARTMENT:
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FORMV OF ECORD (if avarlable)
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I request copies of the records described above and agree to pay the cost of such records in
RECEIVER OF TAXES
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RECREATION
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SUPERVISOR
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TOWN CLERK
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DOCK CONTROL OFFICER El
TOWN ENGINEER ❑
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TOWN OF WAPPINGE
Application for Public Access to Records
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Date Received by Dept
Department Head approval:
Date Applicant Contacted
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Date FOIL fulfilled or denied: 1 /
Closed by:
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Notes:
Amount Due: Pages for a total of $
Name: „' check here if you are
Address: requesting that the records
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Telephone #: ( &Z)3 FAX#: ( ) -
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FORMV OF ECORD (if avarlable)
I 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