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Forms Can Be Submitted via Email to Imcconologue @bto vnofwappingerny.gov or
srobirison a townofwa: inern ov or in parson/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph R Paoloni L
Lori McConologue
Grace Robinson -1
Date Received: _ / /
FOIL Ser. ##:c A� ; -- 13
DEPARTMENT:
ASSESSOR
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ACCOUNTING
CODE ENFORCEMENT
HIGI-IWAY
RECEIVER OF TAXES
RECREATION
SUPERVISOR
TOWN CLERK
DOG CONTROL OFFICER El
TOWN ENGINEER
TOWN ATTORNEY �]
TOWN OF WAPP'IN ER
.Application for Public Access to Records
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ing Department
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Date Deceived by Dept 1_ /
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Department Head approval:
Date Applicant Contacted: / /
Date FOl fti±!le r denied
Closed by:
a
Date: / I
dOA
Notes:
Amount Due: Pages for a total of $.
Name: I a r•, e l Cj-,,_ L,),( Z-ee' Qcheck here if you are
Address. requesting that the records
P-IGIST , t t J `/( be mailed to this address.
Agency or firm: _
Telephone ##: (c,V)"`j - FAX ##: ( -
Email address:
SPECIFIC DESCRIPTION OF RECOR
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FORMAT" OF RECORD (if available)
Irequest 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
I request that the records be faxed to the number listed above