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Forins Can Be Submitted via Ernail to IIIACCOIIOIOI-)Lle(iitowtiof,,�,appin Iei-iiy,gov or
it�_tiisorl,,'ct..to",nof-",at)pjiigei-fiv.,L,,oN, or in person/via, inall to 20 MiddlebUsh Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paolon]
Lori MCC011010gUe
Grace Robinson
Date Received:
FOIL Ser. 4:
DEPARTMENT:
Name: E]check here if you are
ASSESSOR
EJ
ACCOUNTING
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CODE ENFORCEMENT
Agency or Fin -n:__._.
HIGHWAY
Telephone #: ( FAX#:
RECEIVER OF TAXES
Eniall address: L3 L
RECREATION
SUPERVISOR
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'TOWN CI -ERIC
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WATER/SEWER
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DOG CONTROL OFFICER
TOWN ENGINEER
TOWN ATTORNEY
Date Received by Dept 9 /, Z
Department Head approval:
it)
Date Applicant Contacted: 2
Date FOIL fultilled or denied: �2
Closed by:
Date:
Notes:
C)
Amount Due' Pages for a total of
Name: E]check here if you are
Address: S Pf requesting that the records
be mailed to this address.
Agency or Fin -n:__._.
Telephone #: ( FAX#:
Eniall address: L3 L
SPECIFIC DESCRIPTION OF RECORD:
41
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
1
request that the records be sent via c-ina I I to the address listed above
I request that the records be faxed to the number listed above