2025-1002025-100
Resolution Adopting "A Local Law no. 3 for the Purpose of Amending Chapter 240,
Zoning, of the Town Code to include." Short Term Rentals"
At a Regular Meeting of the Town Board of the Town of Wappinger, Dutchess County,
New York, held at Town Hall, 20 Middlebush Road, Wappingers Falls, New York, on April 28,
2025.
The meeting was called to order by Joseph D. Cavaccini, Town Supervisor, and upon roll
being called, the following was recorded:
✓ Vote Record - Resolution RES -2025-100
Yes/Aye
No/Nay
Abstain
Absent
2 Adopted
❑ Adopted as Amended
Joseph D. Cavaccini
Voter
Q
❑
❑
❑
❑ Defeated
William H. Beale
Mover
Q
❑
❑
❑
❑ Tabled
Angela Bettina
Voter
❑
❑
❑
Q
❑ Withdrawn
Christopher Phillips
Seconder
Q
❑
❑
❑
Al Casella
Voter
2
❑
❑
❑
The following Resolution was introduced by Councilman Beale and seconded by
Councilman Phillips.
WHEREAS, the Town Board has considered the adoption of Resolution Introducing "A
Local Law No. 3 for the Purpose of Amending Chapter 240, Zoning, of the Town Code to include."
Short Term Rentals"; and
WHEREAS, a Public Hearing on the proposed Local Law was duly advertised in the
Southern Dutchess News and the Poughkeepsie Journal as required by law; and
WHEREAS, a Public Hearing was held on April 28, 2025 and all parties in attendance were
permitted an opportunity to speak on behalf of or in opposition to said proposed Local Law or any
part thereof; and
WHEREAS, the Town Board has determined that the Proposed Action is an action for which
there are no other Involved Agencies and that the Town Board is therefore, by default, the Lead
Agency for this action; and
WHEREAS, as in accordance with Section 239 of the New York State General Municipal Law,
the Town Board referred the proposed Local Law to the Dutchess County Department of Planning
and Development (DCDPD) for its advisory opinion; and
WHEREAS, in response to said referral the DCDPD responded with document attached; and
WHEREAS, said Local Law has been on the desks of the members of the Town Board of
the Town of Wappinger for at least ten (7) days prior to the adoption of this resolution.
NOW, THEREFORE, BE IT RESOLVED, AS FOLLOWS:
1. The Town Board hereby adopts and incorporates the recitations and statements set
forth above as if fully set forth and resolved herein.
2. The Town Board, after due deliberation, finds that it is in the best interest of the
Town to adopt said Local Law, and the Town Board hereby adopts Local Law No. 3
of 2025, a copy of which is attached hereto and made a part of this Resolution; and
3. The Town Clerk is directed to enter said Local Law in the minutes of this meeting
into the Local Law book for the Town of Wappinger and to give due notice of the
adoption of said Local Law to the Secretary of State of New York.
The foregoing was put to a vote which resulted as follows:
RESULT: ADOPTED [UNANIMOUS]
MOVER: William H. Beale, Councilman
SECONDER: Christopher Phillips, Councilman
AYES: Joseph D. Cavaccini, William H. Beale, Christopher Phillips, Al Casella
ABSENT: Angela Bettina
Dated: Wappingers Falls, New York
4/28/2025
The Resolution is hereby duly declared Adopted.
JOSEP�Ij,"P. PAOLONI, TOWN CLERK
NEW YORK STATE DEPARTMENT OF STATE
STATE STREET
ALBANY, NY 12231
Local Law Filin
(Use this form to file a local law with the Secretary of State.)
Town of WAPPINGER
Local Law No. 3 of the year 2025
A local law entitled "A Local Law 3 for the Purpose of Amendinq Chapter 240, Zoning, of the Town
Code to include." Short Term Rentals"
Be it enacted by the TOWN BOARD of the Town of WAPPINGER as follows:
BE IT ENACTED by the Town Board of the Town of Wappinger as follows:
Section 1. Title
This Local Law shall be known and cited as "Local Law No.3 of 2025, for the Purpose of
Amending Chapter 240, Zoning, of the Town Code with Respect to Short Term Rentals."
Section 2. Legislative Intent
N& Short Term Rentals
Legislative intent. This Local Law is enacted to allow the use of housing units in the Town
of Wappinger for short-term rental purposes so as to enhance the tourism economy of the
Town while protecting the safety of renters and the privacy of residents; ensuring that the
value of housing is tied to its use for residential purposes; and helping to maintain the
affordability of both home ownership and rental units. The intent of this Local Law is to
regulate the use of residential structures for short-term rental purposes by defining such
uses in the Town of Wappinger Zoning Law and providing minimum quality of life,
environmental, land use, building code safety and short-term rental operational
requirements to be met in permitting these uses to be established. This Local Law is
intended to apply to all existing and future housing units in the Town and to dictate the
requirements for the establishment of a short-term rental.
Section 3. Amendments to Chapter 240-69.1 Zoning
DEFINITIONS: As used in this section, the following words shall have the meaning
indicated:
DWELLING UNIT
A building, or portion thereof, providing complete housekeeping facilities for one family.
OCCUPIED PRIMARY RESIDENCE
A dwelling unit used by the owner as his or her primary residence. All owners of the business
entity must use the premises as his or her primary residence. When a property is titled in
the name of a trustee, the property shall be considered an occupied primary residence if the
grantor or grantee is the occupant of the property.
OWNER
Any individual or individuals, partnership or corporation or other organization in possession
of and having a fee interest in the real property. The term "owner" shall include a corporation,
limited -liability company, partnership, association, trustee, or other business entity or
nonbusiness forms of ownership.
PERSON
Any person, individual, corporation, governmental entity, partnership, association, trustee,
or other legal entity.
PRIMARY RESIDENCE
The primary location that a person inhabits throughout the year.
SHORT-TERM RENTAL
A dwelling unit, or a room or group of rooms within a dwelling unit, made available to rent,
lease or otherwise assigned for an occupancy of less than 30 consecutive days. The term
"short-term rental " does not include dormitories, hotel or motel rooms, bed -and -breakfast
inns or lodging houses, as permitted, and regulated by the Town of Wappinger.
T: Short -Term Rental
TENANT
Any person holding a written lease to occupy, use and possess the whole or part of any
building or real property, either alone or with others for more than six months.
Section 4: RESTRICTIONS
The following restrictions shall apply to all short-term rental properties:
1.) Short-term rental properties shall not be located in anything other than a single -
occupancy building. STRs are prohibited in multi -family residences, accessory
buildings, RV's and mobile homes.
2.) Short-term rental properties are permitted in the following Zoning Districts. R-40,
R-40/80, R-80, R -3A & R -5A only. They shall also be prohibited on properties
with nonconforming lots.
3.) Short-term rental properties are prohibited from sharing a driveway with another
property.
4.) Garbage and other refuse can only be left out for collection the night before
pickup, and all refuse containers shall be removed from the curb once emptied.
5.) Short-term rentals may not advertise for occupancy greater than two people per
bed room.
6.) The owner of the property or the owner's agent must respond and be present at
the property upon 24 hours notice when the property is rented.
7.) Not more than one Short -Term rental shall be permitted on any lot.
8.) No short-term rental shall be permitted on any lot which is located within 1,500
feet of any other lot containing a Short -Term rental.
9.) No Short -Term rental shall be permitted in any building which is located within
four hundred feet of any lot on which there is located a school or day-care center.
Section 5: Annual operating permit; application.
A. Application process
1.)The owner of a short-term rental property shall register the property with the
Building Department on an annual basis. The information provided shall include
the name, address, and contact information for the owner, as well as the name,
address, and contact information for the local agent, if different from the owner.
As part of the registration process, each applicant shall complete an annual fire
inspection with the Town of Wappinger Fire Inspector.
2.) In submitting the application for a new permit or any renewal, the owner
consents to an inspection of the property to ensure compliance with all
conditions. The property shall be inspected by the Building Department at the
time of the initial application and prior to any permit renewal, to determine
whether the property remains in compliance with the section and all other
applicable provisions of the Town Code, the International Series of Codes and
New York State Code Supplement. If the Building Inspector determines that the
short-term rental space is not in compliance, the owner shall cease use of the
dwelling unit as a short-term rental until all noncomplying elements have been
corrected and the owner shall apply for reinspection with the Building
Department, subject to an additional fee as set forth in the Town of Wappinger
Fee Schedule.
3.) Permit required. It shall be unlawful to use, establish, maintain, operate, occupy,
rent, or lease any property as a short-term rental without first having obtained a
short-term rental permit.
4.) Copy of utility bill in the applicant's name.
5.) Application fee $250.00
6.) Yearly renewal $250.00 (To include evidence of payment of the hotel
occupancy tax required by Dutchess County for the prior fiscal year.)
B. Required Submittals
The following shall be provided:
1.) A completed annual permit application and fee as designated by the Town
Board by Resolution.
2.) Proof, such as a Health Dept. approval for the structure, that the sanitary sewer
or septic system has the capacity for the number of bedrooms in the structure.
3.) A property map that clearly depicts the property boundaries.
4.) A floor plan showing the location of the short term rental area within the
structure with the location of a smoke detector in each sleeping room and each
other room, the location a fire extinguisher in the kitchen and at each exit, and
at least one carbon monoxide detector. Floor plans are not required to be
professionally prepared.
5.) A safety/egress plan, to be posted in the rental unit in a visible location and on
the back of each bedroom door.
6.) A parking layout plan identifying where visitors' parking is to be located. This
plan shall accommodate sufficient parking for tenants and residents. The
parking shall include one (1) parking space per bedroom plus, one (1)
additional space. Parking design and placement shall be accommodated off-
street and shall not restrict access for fire and safety vehicles.
7.) Provide a waste removal plan. Garbage shall not be allowed to remain
curbside for a period greater than 24 hours and shall be placed within a sealed
container. Property owners shall be responsible for clean-up of any garbage
strewn by animals.
8.) A statement that littering is illegal.
9.) A statement that all outdoor fires must be always attended. Only seasoned
wood may be used for the fire.
1.) STR's must register with Dutchess County and a copy of said registration is to
accompany STR Applications to the Town of Wappinger Building Department.
2.) STR's must pass a yearly fire/safety inspection by the Town of Wappinger Fire
Inspector and the report of said inspection is to be attached to STR annual
renewal permit applications. All STR units must comply with NY State Building
Code requirements and shall have no open violations.
3.) STR shall be limited to Single Rentals (multiple rentals simultaneously are not
permitted) per home.
4.) The STR establishment shall be limited to a maximum capacity of two (2) guests
per bedroom. Children twelve years old and under are not counted as guests.
5.) Complaints and Violations issued by the Town of Wappinger CEO will be
considered at annual renewal. Three (3) Violations within any 12 -month period
or portion thereof will be grounds for permit termination.
6.) Only the property owner is permitted to register an STR.
7.) The host will provide guests with copies of local laws pertaining to noise, fire,
and safety requirements. Emergency contact information as well as E911
address of property shall be clearly identifiable.
8.) The street address of the property shall be clearly identifiable from the street
and shall be posted in a visible location on the bedroom door.
9.) Approved STR's will be assigned a registration number that must be included in
all rental listings, both print and on-line and posted within the STR.
10.) Exterior advertising is prohibited.
11.) Temporary Structures, Sleeping Tents, Trailers, and RVs are not permitted in
this regulation and are prohibited for the purpose of STR.
12.) There shall be one functioning smoke detector in each sleeping room and at
least one functioning smoke detector in at least one other room, one functioning
fire extinguisher in the kitchen and at each exit, and at least one carbon
monoxide detector. In addition, the premises must comply with all NYS Building
and Fire Code regulations, as the same may be amended.
13.) Electrical systems shall be serviceable with no visual defects or unsafe
conditions.
14.) All fireplaces, fireplace inserts or other fuel burning heaters and furnaces shall
be vented and properly installed.
15.) Each sleeping room shall have an exterior exit that opens directly to the
outside, or an emergency escape or rescue window.
16.) No owner shall offer or use any part of the property as a short-term rental not
approved for residential use, including but not limited to, vehicles parked on the
property, a storage shed, recreation room, trailer, garage, or any temporary
structure such as a tent.
17.) A short-term rental property shall not be rented for any other purpose,
commercial or otherwise, not expressly permitted under this section, such as
concerts or weddings or a special event.
18.) The current short-term rental permit shall be prominently displayed inside and
near the front entrance of the short-term rental.
Section 7. Violations.
Any of the following shall constitute a violation of this chapter:
A.
1.) Failure to comply with any provision of this chapter including without limitation by
reason of specification, the Restrictions and the Operational Requirements listed
above and any of the following numbered items.
2.) Advertising or listing an STR without a valid permit or registration, or without
including the permit or registration number on the advertising or listing, or
advertising or listing an STR for a greater occupancy than permitted. Presumptive
evidence. The existence of any of the following shall create a rebuttable
presumption that a property is being utilized as a short-term rental: The property is
offered for lease or rent on a short-term rental website, including but not limited to
Airbnb, NomeAway, VRBO or similar websites; or the property is offered for lease
or rent using any other advertising mechanism for a period of fewer than thirty
consecutive days.
3.) Operation of an STR without a valid permit or registration or for a greater occupancy
than permitted.
4.) Failure to properly display a valid annual operating permit or registration or the
required safety/egress plan, waste management plan, copy of Chapter 166 (Noise.
5.) Fraud or misrepresentation with respect to any information provided to the Town in
connection with the STR application or its operation
6.) Violation of Chapter 166, Noise.
7.) Activity at the property that creates a public nuisance, or otherwise constitutes a
danger to the public health, safety, welfare, or morals.
8.) Failure to have on operating smoke detector or carbon monoxide detector or having
an expired fire extinguisher.
B.
Suspension or revocation of a permit or registration.
1.) A notice of violation may be issued by the Zoning Enforcement Officer or Building
Inspector for any violation of this Chapter. The notice of violation shall describe
the violation and require the permit holder to immediately correct the violation or
cause the violation to be corrected.
2.) The notice of violation shall be provided to the permit holder by personal service,
by regular mail to the address submitted with the permit application, or by posting
at the STR.
3.) Failure to correct the violation or cause the violation to be corrected shall be
grounds for immediate suspension or revocation of the permit or registration.
C.
Enforcement.
1.) The requirements established by this chapter shall be administered and
enforced by any law enforcement agency that has jurisdiction in the Town of
Wappinger, the Town of Wappinger Zoning Enforcement Officer, Code
Enforcement Official/Building Inspector and Town Attorney or his/her designee
and such other employees and/or officials authorized by the Town Board.
2.) In addition to any administrative remedy, pursuant to the provisions of
Municipal Nome Rule Law, § 10, Subdivision 4(a), and the Criminal Procedure
Law, § 150.10, Police Officers, the Zoning Enforcement Officer and Code
Enforcement Official/Building Inspector of the Town of Wappinger are hereby
authorized to issue and serve appearance tickets, as defined in the Criminal
Procedure Law, returnable in Town Court of the Town of Wappinger, when he
or she has reasonable cause to believe a person has violated, in his or her
presence, Chapter 240-69.1 of the Code of the Town of Wappinger, entitled
"Short -Term Rentals," and to prosecute the violation in Town Court.
D.
Penalties for offenses.
1.) Violation of any provision or requirement of this chapter or violation of any
statement, application, permit, or registration approved under the provisions of
this chapter shall be considered an offense punishable by a fine set annually by
resolution of the Town Board which shall not be less than $500 and/or
imprisonment for not more than six months for a first offense; for conviction of a
second offense, both of which were committed within a period of five years,
punishable by a fine of not less than $1,000 nor more than $2,000 and/or
imprisonment for not more than six months; and upon conviction for a third or
subsequent time within a period of five years, punishable by a fine of not less than
$3,000 nor more than $5,000 and/or imprisonment for a period of not more than
six months.
2.) The owner, agent, or operator of a building, premises, or part thereof where such
violation has been committed or does exist and any agent, corporation or other
person who commits, takes part, or assists in such violation shall be individually
liable for such an offense. All such penalties shall be collectible by and in the name
of the Town. Every week that any such violation continues after notification that
such violation exists shall constitute a separate chargeable offense.
3.) Conviction of a violation of this chapter shall constitute and effect an immediate
forfeiture of any permit or registration hereunder held by the person so convicted.
4.) Without limiting any other remedy, the Town Board may also maintain an action
or proceeding in the name of the Town in a court of competent jurisdiction to
compel compliance with, or to restrain by injunction the violation of, this chapter.
Section 8. Zoning Amendment
District Schedule of Use Regulations shall be amended by adding a new use category
entitled Short -Term Rentals, which shall be permitted, subject to issuance of a permit by the
Town of Wappinger Building Department, under the heading ACCESSORY USES and shall
be added under residential uses as Permitted (P), in R-40, R-40/80, R-80, R -3A & R -5A
District zoning districts.
Amend Chapter 240 Attachment 2 Schedule of Use Regulations Residential Districts
Town of Wappinger to include Short Term Rentals as a permitted use with a building
permit in the R-40, R-40/80, R-80, R -3A & R -5A District.
Section 9. Ratification, Readoption and Confirmation
Except as specifically modified by the amendments contained herein, the Code of the Town
of Wappinger as adopted and amended from time to time thereafter is otherwise to remain
in full force and effect and is otherwise ratified, readopted, and confirmed.
Section 10. Numbering for Codification
It is the intention of the Town of Wappinger and it is hereby enacted that the provisions of
this Local Law shall be included in the Code of the Town of Wappinger; that the sections
and sub -sections of this Local Law may be re -numbered or re -lettered by the Codifier to
accomplish such intention; that the Codifier shall make no substantive changes to this Local
Law; that the word "Local Law" shall be changed to "Chapter," "Section" or other appropriate
word as required for codification; and that any such rearranging of the numbering and editing
shall not affect the validity of this Local Law or the provisions of the Code affected thereby.
Section 11. Severable
The provisions of this Local Law are severable and if any provision, clause, sentence,
subsection, word or part thereof is held illegal, invalid or unconstitutional, or inapplicable to
any person or circumstance, such illegality, invalidity, or unconstitutionality, or inapplicability,
shall not affect or impair any of the remaining provisions, clauses, sentences, subsections,
words or parts of this Local Law or their application to other persons or circumstances. It is
hereby declared to be the legislative intent of the Town Board of the Town of Wappinger that
this Local Law would have been adopted if such illegal, invalid or unconstitutional provision,
clause, sentence, subsection, word or part had not been included therein, and if such person
or circumstance to which the Local Law or part thereof is held inapplicable had been
specifically exempt therefrom.
Section 12. Effective Date
This Local Law shall take effect immediately upon filing with the Secretary of State as
provided by the Municipal Home Rule Law.
Dutchess County Department ofi
Planning and Development
Co./Crept.
Fax #
k
Crate #pgs
Frorr�
PHror,e #
239 Planning/Zoning Referral - Exemption Communities
Municipality: Town of Wappinger
Referring Agency: Municipal Board
Tax Parcel Numbers(s):
Project Name: Short Term Rentals Local Law
Applicant: Town of Wappinger Town Board
Address of Property:
Exempt Actions:*
239 Review is NOT Required
• Administrative Amendments (fees,
procedures, penalties, etc.)
• Special Permits for residential uses
(accessory apts, home occupations,
etc.)
• Use Variances for residential uses
• Area Variances for residential uses
• Renewals/Extension of Site Plans or
Special Permits that have no changes
from previous approvals
No Authority to review these Actions
• Subdivisions / Lot Line Adjustments
• Interpretations
F-1Exempt Action submitted for informal
review
Date Response Requested: 4/14/2025
Entered By: Paoloni, Joseph
Actions Requiring 239 Review
Comprehensive/Master Plans
®Zoning Amendments (standards, uses,
definitions, district regulations, etc.)
F-1Other Local Laws associated with zoning
(wetlands, historic preservation, affordable
housing, architectural review, etc.)
❑ Rezonings involving all map changes
Architectural Review
❑ Site Plans (all)
❑ Special Permits for all non-residential uses
❑ Use Variances for all non-residential uses
❑ Area Variances for all non-residential uses
n Other (Describe):
Parcels within 500 feet of:
❑ State Road:
❑ County Road:
F-1State Property (with recreation area
or public building)
F-1County Property (with recreation
area or public building)
❑ Municipal Boundary
F-1Farm operation in an Agricultural
District
'These actions are only exempt in municipalities that signed an intermunicipal agreemment with Dutchess County to that effect.'
For County Office Use Only
Response From Dutchess County Department of Planning and Development
No Comments:
ElMatter of Local Concern
❑ No Jurisdiction
❑ No Authority
❑ Withdrawn
❑ Incomplete - municipality must resubmit to County
❑ Exempt from 239 Review
F-1 None
Date Submitted:
Date Received:
Date Requested: 4/14/2025
Date Required:
.....................................................................................................................................
Date Transmitted:
Notes:
Comments Attached:
0 Local Concern with Comments
❑ Conditional
❑ Denial
❑ Incomplete with Comments- municipality must resubmit to County
❑ Informal Comments Only (Action Exempt from 239 Review)
Also mailed
hard copy
Reviewer:
Major Project
Referral #: ZR25-087
Date Printed: 4/10/2025
Full Environmental Assessment Form
Part 1- Project and Setting
Instructions for Completing Part 1
Part 1 is to be completed by the applicant or project sponsor. Responses become part of the application for approval or funding,
are subject to public review, and may be subject to further verification.
Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to
any item, please answer as thoroughly as possible based on current information; indicate whether missing information does not exist,
or is not reasonably available to the sponsor; and, when possible, generally describe work or studies which would be necessary to
update or fully develop that information.
Applicants/sponsors must complete all items in Sections A & B. In Sections C, D & E, most items contain an initial question that
must be answered either "Yes" or "No". If the answer to the initial question is "Yes", complete the sub -questions that follow. If the
answer to the initial question is "No", proceed to the next question. Section F allows the project sponsor to identify and attach any
additional information. Section G requires the name and signature of the applicant or project sponsor to verify that the information
contained in Part lis accurate and complete.
A. Project and Applicant/Sponsor Information.
Name of Action or Project:
Local Law No. _ of 2025
Project Location (describe, and attach a general location map):
Amendment to Chapter 240 of Zoning Code- affecting the R-40; R-40/80; R -3A and R5A Zoning
Districts
Brief Description of Proposed Action (include purpose or need):
Amendment to Chapter 240 of the Town of Wappinger Town Code (Zoning) to regulate short term rentals. Currently numerous short term rentals exist in
the Town of Wappinger and the Zoning Code does not regulate the use. The intent is to regulate the use to provide minimum safety and use requirements
for property owners who engage in the short term rental of their property.
Name of Applicant/Sponsor:
Town of Wappinger Town Board
Telephone: 845 297 2744
E -Mail: jcavacinni@townofwappingerny.gov
Address: 20 Middlebush Road
City/PO: Wappingers Falls
State: New York
Zip Code: 12590
Project Contact (if not same as sponsor; give name and title/role):
Joseph Cavacinni, Supervisor
Telephone: same as above
E -Mail: same as above
Address:
20 Middlebush Road
City/PO:
Wappinger Falls
State:
Zip Code:
Property Owner (if not same as sponsor):
Telephone:
E -Mail:
Address:
City/PO:
State:
Zip Code:
Page 1 of 13
FEAF 2019
B. Government Approvals
B. Government Approvals, Funding, or Sponsorship. ("Funding" includes grants, loans, tax relief, and any other forms of financial
assistance.)
Government Entity
If Yes: Identify Agency and Approval(s)
Application Date
Required
(Actual or projected)
a. City Council, Town Board, OYesONO
Adoption by Town Board of Local Law
April 2025
or Village Board of Trustees
b. City, Town or Village ®Yes❑No
Planning Board Referral
April 2025
Planning Board or Commission
c. City, Town or ❑YesRlNo
Village Zoning Board of Appeals
d. Other local agencies ❑Yes®No
e. County agencies 0YesF-1No
County Referral
April 2025
f Regional agencies ❑Yes®No
g. State agencies ❑Yes®No
h. Federal agencies ❑Yes®No
i. Coastal Resources.
i. Is the project site within a Coastal Area, or the waterfront area of a Designated Inland Waterway? ®Yes ❑No
ii. Is the project site located in a community with an approved Local Waterfront Revitalization Program? ® Yes❑No
iii. Is the project site within a Coastal Erosion Hazard Area? ❑ Yes®No
C. Planning and Zoning
C.1. Planning and zoning actions.
Will administrative or legislative adoption, or amendment of a plan, local law, ordinance, rule or regulation be the
only approval(s) which must be granted to enable the proposed action to proceed?
• If Yes, complete sections C, F and G.
• If No, proceed to question C.2 and complete all remaining sections and questions in Part 1
®Yes❑No
C.2. Adopted land use plans.
a. Do any municipally- adopted (city, town, village or county) comprehensive land use plan(s) include the site
where the proposed action would be located?
If Yes, does the comprehensive plan include specific recommendations for the site where the proposed action
would be located?
®Yes❑No
❑Yes®No
b. Is the site of the proposed action within any local or regional special planning district (for example: Greenway;
Brownfield Opportunity Area (BOA); designated State or Federal heritage area; watershed management plan;
or other?)
If Yes, identify the plan(s):
The Hudson River is a National Heritage Landmark. The proposed action does not propose any changes.
®Yes❑No
c. Is the proposed action located wholly or partially within an area listed in an adopted municipal open space plan,
or an adopted municipal farmland protection plan?
If Yes, identify the plan(s):
Dutchess County Greenway Cpmpact 2004-, Dutchess County Ag and Farmland Protection Plan
®Yes❑No
Page 2 of 13
C.3. Zoning
a, Is the site of the proposed action located in a municipality with an adopted zoning law or ordinance, ®YesMNo
If Yes, what is the zoning classification(s) including any applicable overlay district?
R-40; R-40/80; R -3A and R -5A
b. Is the use permitted or allowed by a special or conditional use permit? ❑Yes®No
c. Is a zoning change requested as part of the proposed action? ❑Yes®No
If Yes,
i, What is the proposed new zoning for the site?
CA. Existing community services.
a. In what school district is the project site located? Wappinger Central School
b. What police or other public protection forces serve the project site?
NYS Police Troop K- 18 Middlebush Road, Wappingers Falls.
c. Which fire protection and emergency medical services serve the project site?
Hughsonville Fire District, New Hackensack Fire District and Chelsea Fire District
d. What parks serve the project site?
rport Park, Brexel Schlathaus, Carnwarth Farms, Caste Point, Fleetwood Park, Martz Field, Quiet Acres, Reese Park, Robinson Lane Baseball Complex,
Rockingham
D. Project Details
D.I. Proposed and Potential Development
a. What is the general nature of the proposed action (e.g., residential, industrial, commercial, recreational; if mixed, include all
components)? Provide use and safety requirements for short term rentals including registration of use with Town.
b, a. Total acreage of the site of the proposed action? acres
b. Total acreage to be physically disturbed? acres
c. Total acreage (project site and any contiguous properties) owned
or controlled by the applicant or project sponsor? acres
c. Is the proposed action an expansion of an existing project or use? ❑ Yes® No
i. If Yes, what is the approximate percentage of the proposed expansion and identify the units (e.g., acres, miles, housing units,
square feet)? % Units:
d. Is the proposed action a subdivision, or does it include a subdivision? ❑Yes ®No
If Yes,
i. Purpose or type of subdivision? (e.g., residential, industrial, commercial; if mixed, specify types)
ii. Is a cluster/conservation layout proposed? ❑Yes ❑No
iii. Number of lots proposed?
iv. Minimum and maximum proposed lot sizes? Minimum Maximum
e. Will the proposed action be constructed in multiple phases? ❑Yes®No
i. If No, anticipated period of construction: months
ii. If Yes:
• Total number of phases anticipated
• Anticipated commencement date of phase 1 (including demolition) month year
• Anticipated completion date of final phase month year
• Generally describe connections or relationships among phases, including any contingencies where progress of one phase may
determine timing or duration of future phases:
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f. Does the project include new residential uses? ❑Yes®No
If Yes, show numbers of units proposed.
One Family Two Familv Three Familv Multiple Familv four or more
Initial Phase
At completion
of all phases
g. Does the proposed action include new non-residential construction (including expansions)? ❑Yes®No
If Yes,
i. Total number of structures
ii. Dimensions (in feet) of largest proposed structure: height; width; and length
iii. Approximate extent of building space to be heated or cooled: square feet
h. Does the proposed action include construction or other activities that will result in the impoundment of any ❑Yes®No
liquids, such as creation of a water supply, reservoir, pond, lake, waste lagoon or other storage?
If Yes,
i. Purpose of the impoundment:
ii. If a water impoundment, the principal source of the water: ❑ Ground water ❑ Surface water streams ❑Other specify:
iii. If other than water, identify the type of impounded/contained liquids and their source.
iv. Approximate size of the proposed impoundment. Volume: million gallons; surface area: acres
v. Dimensions of the proposed darn or impounding structure: height; length
vi. Construction method/materials for the proposed dam or impounding structure (e.g., earth fill, rock, wood, concrete):
D.2. Project Operations
a. Does the proposed action include any excavation, mining, or dredging, during construction, operations, or both? ❑Yes®No
(Not including general site preparation, grading or installation of utilities or foundations where all excavated
materials will remain onsite)
If Yes:
i . What is the purpose of the excavation or dredging?
ii. How much material (including rock, earth, sediments, etc.) is proposed to be removed from the site?
• Volume (specify tons or cubic yards):
• Over what duration of time?
iii. Describe nature and characteristics of materials to be excavated or dredged, and plans to use, manage or dispose of them.
iv. Will there be onsite dewatering or processing of excavated materials? Yes No
If yes, describe.
v. What is the total area to be dredged or excavated? acres
vi. What is the maximum area to be worked at any one time? acres
vii. What would be the maximum depth of excavation or dredging? feet
viii. Will the excavation require blasting? ❑YesONo
ix. Summarize site reclamation goals and plan:
b. Would the proposed action cause or result in alteration of, increase or decrease in size of, or encroachment ❑Yes®No
into any existing wetland, waterbody, shoreline, beach or adjacent area?
If Yes:
i. Identify the wetland or waterbody which would be affected (by name, water index number, wetland map number or geographic
description):
Page 4 of 13
ii. Describe how the proposed action would affect that waterbody or wetland, e.g. excavation, fill, placement of structures, or
alteration of channels, banks and shorelines. Indicate extent of activities, alterations and additions in square feet or acres:
iii. Will the proposed action cause or result in disturbance to bottom sediments?
❑Yes❑No
If Yes, describe:
N. Will the proposed action cause or result in the destruction or removal of aquatic vegetation?
❑ Yes❑No
If Yes:
• acres of aquatic vegetation proposed to be removed:
• expected acreage of aquatic vegetation remaining after project completion:
• purpose of proposed removal (e.g. beach clearing, invasive species control, boat access):
• proposed method of plant removal:
• if chemical/herbicide treatment will be used, specify product(s):
v. Describe any proposed reclamation/mitigation following disturbance:
c. Will the proposed action use, or create a new demand for water?
❑Yes ®No
If Yes:
i. Total anticipated water usage/demand per day: gallons/day
ii. Will the proposed action obtain water from an existing public water supply?
❑Yes ❑No
If Yes:
• Name of district or service area:
• Does the existing public water supply have capacity to serve the proposal?
❑ Yes❑ No
• Is the project site in the existing district?
❑ Yes❑ No
• Is expansion of the district needed?
❑ Yes❑ No
• Do existing lines serve the project site?
❑ Yes❑ No
iii. Will line extension within an existing district be necessary to supply the project?
❑Yes ❑No
If Yes:
• Describe extensions or capacity expansions proposed to serve this project:
• Source(s) of supply for the district:
iv. Is a new water supply district or service area proposed to be formed to serve the project site?
❑ Yes❑No
If, Yes:
• Applicant/sponsor for new district:
• Date application submitted or anticipated:
• Proposed source(s) of supply for new district:
v. If a public water supply will not be used, describe plans to provide water supply for the project:
vi. If water supply will be from wells (public or private), what is the maximum pumping capacity:
gallons/minute.
d. Will the proposed action generate liquid wastes?
❑ Yes ®No
If Yes:
i. Total anticipated liquid waste generation per day: gallons/day
ii. Nature of liquid wastes to be generated (e.g., sanitary wastewater, industrial; if combination, describe
all components and
approximate volumes or proportions of each):
iii. Will the proposed action use any existing public wastewater treatment facilities?
F-1 Yes ®No
If Yes:
• Name of wastewater treatment plant to be used:
• Name of district:
• Does the existing wastewater treatment plant have capacity to serve the project?
❑Yes ❑No
• Is the project site in the existing district?
❑Yes ❑No
• Is expansion of the district needed?
❑ Yes ❑No
Page 5 of 13
• Do existing sewer lines serve the project site?
❑Yes❑No
• Will a line extension within an existing district be necessary to serve the project?
❑Yes❑No
If Yes:
• Describe extensions or capacity expansions proposed to serve this project:
iv. Will a new wastewater (sewage) treatment district be formed to serve the project site?
❑Yes®No
If Yes:
• Applicant/sponsor for new district:
• Date application submitted or anticipated:
• What is the receiving water for the wastewater discharge?
v. If public facilities will not be used, describe plans to provide wastewater treatment for the project, including specifying
receiving water (name and classification if surface discharge or describe subsurface disposal plans):
proposed
vi. Describe any plans or designs to capture, recycle or reuse liquid waste:
e. Will the proposed action disturb more than one acre and create stormwater runoff, either from new point
❑Yes®No
sources (i.e. ditches, pipes, swales, curbs, gutters or other concentrated flows of stor nwater) or non -point
source (i.e. sheet flow) during construction or post construction?
If Yes:
i. How much impervious surface will the project create in relation to total size of project parcel?
Square feet or acres (impervious surface)
Square feet or acres (parcel size)
ii. Describe types of new point sources.
iii. Where will the stormwater runoff be directed (i.e. on-site stormwater management facility/structures, adjacent properties,
groundwater, on-site surface water or off-site surface waters)?
• If to surface waters, identify receiving water bodies or wetlands:
• Will stormwater runoff flow to adjacent properties?
iv. Does the proposed plan minimize impervious surfaces, use pervious materials or collect and re -use stormwater?
❑ Yes[-] No
❑ Yes❑ No
f. Does the proposed action include, or will it use on-site, one or more sources of air emissions, including fuel
❑Yes ®No
combustion, waste incineration, or other processes or operations?
If Yes, identify:
i. Mobile sources during project operations (e.g., heavy equipment, fleet or delivery vehicles)
ii. Stationary sources during construction (e.g., power generation, structural heating, batch plant, crushers)
iii. Stationary sources during operations (e.g., process emissions, large boilers, electric generation)
g. Will any air emission sources named in D.2.f (above), require a NY State Air Registration, Air Facility Permit,
❑Yes ®No
or Federal Clean Air Act Title IV or Title V Permit?
If Yes:
i. Is the project site located in an Air quality non -attainment area? (Area routinely or periodically fails to meet
ambient air quality standards for all or some parts of the year)
❑Yes ❑No
ii. In addition to emissions as calculated in the application, the project will generate:
• Tons/year (short tons) of Carbon Dioxide (CO2)
• Tons/year (short tons) of Nitrous Oxide (N20)
• Tons/year (short tons) of Perfluorocarbons (PFCs)
• Tons/year (short tons) of Sulfur Hexafluoride (SF6)
• Tons/year (short tons) of Carbon Dioxide equivalent of Hydroflourocarbons (HFCs)
• Tons/year (short tons) of Hazardous Air Pollutants (HAPS)
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h. Will the proposed action generate or emit methane (including, but not limited to, sewage treatment plants,
❑Yes®No
landfills, composting facilities)?
If Yes:
L Estimate methane generation in tons/year (metric):
ii. Describe any methane capture, control or elimination measures included in project design (e.g., combustion to generate
heat or
electricity, flaring):
i. Will the proposed action result in the release of air pollutants from open-air operations or processes, such as
❑Yes❑ No
quarry or landfill operations?
If Yes: Describe operations and nature of emissions (e.g., diesel exhaust, rock particulates/dust):
j. Will the proposed action result in a substantial increase in traffic above present levels or generate substantial
❑Yes®No
new demand for transportation facilities or services?
If Yes:
i. When is the peak traffic expected (Check all that apply): ❑ Morning ❑ Evening ❑Weekend
❑ Randomly between hours of to
ii. For commercial activities only, projected number of truck trips/day and type (e.g., semi trailers and dump trucks):
iii. Parking spaces: Existing Proposed Net increase/decrease
iv. Does the proposed action include any shared use parking?
❑Yes ❑No
v If the proposed action includes any modification of existing roads, creation of new roads or change in existing
access, describe:
vi. Are public/private transportation service(s) or facilities available within %2 mile of the proposed site?
vii Will the proposed action include access to public transportation or accommodations for use of hybrid, electric
❑Yes❑No
❑Yes❑No
or other alternative fueled vehicles?
viii. Will the proposed action include plans for pedestrian or bicycle accommodations for connections to existing
❑Yes❑No
pedestrian or bicycle routes?
k. Will the proposed action (for commercial or industrial projects only) generate new or additional demand
❑YesONo
for energy?
If Yes:
i. Estimate annual electricity demand during operation of the proposed action:
ii. Anticipated sources/suppliers of electricity for the project (e.g., on-site combustion, on-site renewable, via grid/local utility, or
other):
iii. Will the proposed action require a new, or an upgrade, to an existing substation?
❑Yes❑No
1. Hours of operation. Answer all items which apply.
i. During Construction: ii. During Operations:
• Monday - Friday: N/A • Monday - Friday: N/A
• Saturday: • Saturday:
• Sunday: • Sunday:
• Holidays: • Holidays:
Page 7 of 13
m. Will the proposed action produce noise that will exceed existing ambient noise levels during construction,
operation, or both?
If yes:
i. Provide details including sources, time of day and duration:
❑ Yes ®No
ii. Will the proposed action remove existing natural barriers that could act as a noise barrier or screen?
Describe:
❑ Yes ❑No
n. Will the proposed action have outdoor lighting?
If yes:
i. Describe source(s), location(s), height of fixture(s), direction/aim, and proximity to nearest occupied structures:
❑ Yes ®No
ii. Will proposed action remove existing natural barriers that could act as a light barrier or screen?
Describe:
❑ Yes ❑No
o. Does the proposed action have the potential to produce odors for more than one hour per day?
If Yes, describe possible sources, potential frequency and duration of odor emissions, and proximity to nearest
occupied structures:
❑ Yes ®No
p. Will the proposed action include any bulk storage of petroleum (combined capacity of over 1,100 gallons)
or chemical products 185 gallons in above ground storage or any amount in underground storage?
If Yes:
i. Product(s) to be stored
ii. Volume(s) per unit time (e.g., month, year)
iii. Generally, describe the proposed storage facilities:
❑ Yes ®No
q. Will the proposed action (commercial, industrial and recreational projects only) use pesticides (i.e., herbicides,
insecticides) during constriction or operation?
If Yes:
i. Describe proposed treatment(s):
❑ Yes ®No
ii. Will the proposed action use Integrated Pest Management Practices?
❑ Yes ❑No
r. Will the proposed action (commercial or industrial projects only) involve or require the management or disposal
of solid waste (excluding hazardous materials)?
If Yes:
i. Describe any solid waste(s) to be generated during construction or operation of the facility:
• Construction: tons per (unit of time)
• Operation : tons per (unit of time)
ii. Describe any proposals for on-site minimization, recycling or reuse of materials to avoid disposal as solid waste:
• Constriction:
❑ Yes ®No
• Operation:
iii. Proposed disposal methods/facilities for solid waste generated on-site:
• Construction:
• Operation:
Page 8 of 13
s. Does the proposed action include construction or modification of a solid waste management facility? ❑ Yes ® No
If Yes:
i. Type of management or handling of waste proposed for the site (e.g., recycling or transfer station, composting, landfill, or
other disposal activities):
ii. Anticipated rate of disposal/processing:
• Tons/month, if transfer or other non-combustion/thermal treatment, or
• Tons/hour, if combustion or thermal treatment
iii. If landfill, anticipated site life: years
t. Will the proposed action at the site involve the commercial generation, treatment, storage, or disposal of hazardous ❑Yes®No
waste?
If Yes:
i. Name(s) of all hazardous wastes or constituents to be generated, handled or managed at facility:
ii. Generally describe processes or activities involving hazardous wastes or constituents:
iii. Specify amount to be handled or generated tons/month
iv. Describe any proposals for on-site minimization, recycling or reuse of hazardous constituents:
v. Will any hazardous wastes be disposed at an existing offsite hazardous waste facility? Yes No
If Yes: provide name and location of facility:
If No: describe proposed management of any hazardous wastes which will not be sent to a hazardous waste facility:
E. Site and Setting of Proposed Action
E.1. Land uses on and surrounding the project site
a. Existing land uses.
i. Check all uses that occur on, adjoining and near the project site.
❑ Urban ❑ Industrial ❑ Commercial ® Residential (suburban) ❑ Rural (non-farm)
❑ Forest ❑ Agriculture ❑ Aquatic ❑ Other (specify):
ii. If mix of uses,, generally describe:
b. Land uses and covertypes on the project site.
Land use or
Covertype
Current
Acreage
Acreage After
Project Completion
Change
(Acres +/-)
• Roads, buildings, and other paved or impervious
surfaces
N?A
N/A
N/A
• Forested
• Meadows, grasslands or brushlands (non-
agricultural, including abandoned agricultural)
• Agricultural
(includes active orchards, field, greenhouse etc.)
• Surface water features
(lakes, ponds, streams, rivers, etc.)
• Wetlands (freshwater or tidal)
• Non -vegetated (bare rock, earth or fill)
• Other
Describe:
Page 9 of 13
c. Is the project site presently used by members of the community for public recreation?
❑YesONo
L If Yes: explain:
d. Are there any facilities serving children, the elderly, people with disabilities (e.g., schools, hospitals, licensed
❑Yes®No
day care centers, or group homes) within 1500 feet of the project site?
If Yes,
i. Identify Facilities:
e. Does the project site contain an existing darn?
❑Yes®No
If Yes:
i. Dimensions of the dam and impoundment:
• Dam height: feet
• Dam length: feet
• Surface area: acres
• Volume impounded: gallons OR acre-feet
ii. Dam's existing hazard classification:
iii. Provide date and summarize results of last inspection:
f Has the project site ever been used as a municipal, commercial or industrial solid waste management facility,
❑Yes®No
or does the project site adjoin property which is now, or was at one time, used as a solid waste management facility?
If Yes:
i. Has the facility been formally closed?
❑Yes❑ No
• If yes, cite sources/documentation:
ii. Describe the location of the project site relative to the boundaries of the solid waste management facility:
W. Describe any development constraints due to the prior solid waste activities:
g. Have hazardous wastes been generated, treated and/or disposed of at the site, or does the project site adjoin
❑Yes®No
property which is now or was at one time used to commercially treat, store and/or dispose of hazardous waste?
If Yes:
i. Describe waste(s) handled and waste management activities, including approximate time when activities occurred:
h. Potential contamination history. Has there been a reported spill at the proposed project site, or have any
❑Yes® No
remedial actions been conducted at or adjacent to the proposed site?
If Yes:
i. Is any portion of the site listed on the NYSDEC Spills Incidents database or Environmental Site
❑Yes❑No
Remediation database? Check all that apply:
❑ Yes — Spills Incidents database Provide DEC ID number(s):
❑ Yes — Environmental Site Remediation database Provide DEC ID number(s):
❑ Neither database
ii. If site has been subject of RCRA corrective activities, describe control measures:
W. Is the project within 2000 feet of any site in the NYSDEC Environmental Site Remediation database?
❑Yes❑No
If yes, provide DEC ID number(s):
iv. If yes to (i), (ii) or (iii) above, describe current status of site(s):
Page 10 of 13
v. Is the project site subject to an institutional control limiting property uses?
❑Yes7No
• If yes, DEC site ID number:
• Describe the type of institutional control (e.g., deed restriction or easement):
• Describe any use limitations:
• Describe any engineering controls:
• Will the project affect the institutional or engineering controls in place?
❑Yes❑No
• Explain:
E.2. Natural Resources On or Near Project Site A, � t.
a. What is the average depth to bedrock on the project site? N/A feet
b. Are there bedrock outcroppings on the project site?
❑YesONo
If Yes, what proportion of the site is comprised of bedrock outcroppings? %
c. Predominant soil type(s) present on project site:
%
d. What is the average depth to the water table on the project site? Average: feet
e. Drainage status of project site soils:❑ Well Drained: % of site
❑ Moderately Well Drained: % of site
❑ Poorly Drained % of site
f Approximate proportion of proposed action site with slopes: ❑ 0-10%: % of site
❑ 10-15%: % of site
❑ 15% or greater: % of site
g. Are there any unique geologic features on the project site?
❑Yes®No
If Yes, describe:
h. Surface water features.
i. Does any portion of the project site contain wetlands or other waterbodies (including streams, rivers,
❑Yes❑No
ponds or lakes)?
ii. Do any wetlands or other waterbodies adjoin the project site?
❑YesMNo
If Yes to either i or ii, continue. If No, skip to E.2.i.
iii. Are any of the wetlands or waterbodies within or adjoining the project site regulated by any federal,
❑Yes ❑No
state or local agency?
iv. For each identified regulated wetland and waterbody on the project site, provide the following information:
Streams: Name Classification
• Lakes or Ponds: Name Classification
i Wetlands: Name Approximate Size
• Wetland No. (if regulated by DEC)
v. Are any of the above water bodies listed in the most recent compilation of NYS water quality-impaired
❑Yes ❑No
waterbodies?
If yes, name of impaired water body/bodies and basis for listing as impaired:
i. Is the project site in a designated Floodway?
❑Yes❑No
j. Is the project site in the 100-year Floodplain?
❑Yes ❑No
k. Is the project site in the 500-year Floodplain?
❑Yes ❑No
1. Is the project site located over, or immediately adjoining, a primary, principal or sole source aquifer?
❑Yes❑No
If Yes:
i. Name of aquifer:
Page 11 of 13
in. Identify the predominant wildlife species that occupy or use the project site:
n. Does the project site contain a designated significant natural community?
❑Yes❑No
If Yes:
i. Describe the habitat/community (composition, function, and basis for designation):
ii. Source(s) of description or evaluation:
W. Extent of community/habitat:
• Currently: acres
• Following completion of project as proposed: acres
• Gain or loss (indicate + or -): acres
o. Does project site contain any species of plant or animal that is listed by the federal government or NYS as
❑ Yes❑No
endangered or threatened, or does it contain any areas identified as habitat for an endangered or threatened species?
If Yes:
i. Species and listing (endangered or threatened):
p. Does the project site contain any species of plant or animal that is listed by NYS as rare, or as a species of
Yes❑No
special concern?
If Yes:
i. Species and listing:
q. Is the project site or adjoining area currently used for hunting, trapping, fishing or shell fishing?
❑Yes❑No
If yes, give a brief description of how the proposed action may affect that use:
,1 -
E.3. Designated Public Resources On or Near Project Site 4,114-
a. Is the project site, or any portion of it, located in a designated agricultural district certified pursuant to
a.
❑Yes❑No
Agriculture and Markets Law, Article 25 -AA, Section 303 and 304?
If Yes, provide county plus district name/number:
b. Are agricultural lands consisting of highly productive soils present?
Yes ❑No
i. If Yes: acreage(s) on project site?
H. Source(s) of soil rating(s):
c. Does the project site contain all or part of, or is it substantially contiguous to, a registered National
[-]Yes []No
Natural Landmark?
If Yes:
i. Nature of the natural landmark: ❑ Biological Community ❑ Geological Feature
ii. Provide brief description of landmark, including values behind designation and approximate size/extent:
d. Is the project site located in or does it adjoin a state listed Critical Environmental Area?
❑Yes❑No
If Yes:
i. CEA name:
ii. Basis for designation:
W. Designating agency and date:
Page 12 of 13
e. Does the project site contain, or is it substantially contiguous to, a building, archaeological site, or district
❑ Yesn No
which is listed on the National or State Register of Historic Places, or that has been determined by the Commissioner of the NYS
Office of Parks, Recreation and Historic Preservation to be eligible for listing on the State Register of Historic Places?
If Yes:
i. Nature of his resource: El Archaeological Site ❑Historic Building or District
ii. Name:
iii. Brief description of attributes on which listing is based:
f. Is the project site, or any portion of it, located in or adjacent to an area designated as sensitive for
DYes E]No
archaeological sites on the NY State Historic Preservation Office (SHPO) archaeological site inventory?
g. Have additional archaeological or historic site(s) or resources been identified on the project site?
❑YesF]No
If Yes:
i. Describe possible resource(s):
ii. Basis for identification:
h. Is the project site within fives miles of any officially designated and publicly accessible federal, state, or local
❑Yes nNo
scenic or aesthetic resource?
If Yes:
i. Identify resource:
ii. Nature of, or basis for, designation (e.g., established highway overlook, state or local park„ state historic trail or scenic byway,
etc.):
iii. Distance between project and resource: miles.
i. Is the project site located within a designated river corridor under the Wild, Scenic and Recreational Rivers
❑ YesE]No
Program 6 NYCRR 666?
If Yes:
i. Identify the name of the river and its designation:
ii. Is the activity consistent with development restrictions contained in 6NYCRR Part 666?
❑Yes ❑No
F. Additional Information
Attach any additional information which may be needed to clarify your project.
If you have identified any adverse impacts which could be associated with your proposal, please describe those impacts plus any
measures which you propose to avoid or minimize them.
G. Verification
I certify that the information provided is true to the best of my knowledge.
Applicant/Sponsor Name „ Dated
Signaturk, _ ' - - Title ��t d �l ✓�
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