Affirmation of Dutchess County Residence
TOWN OF WAPPINGER
TOWN CLERK
CHRIS MASTERSON
SUPERVISOR
CHRISTOPHER J. COLSEY
TOWN CLERK'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
(845) 297-5771
FAX: (845) 298-1478
TOWN COUNCIL
WILLIAM H. BEALE
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOLONI
AFFIRMATION OF DUTCHESS COUNTY RESIDENCE
Last Name:
First Name:
Street Address:
City:
State:
Zip:
I do hereby swear that I am aU. S. citizen or have been granted permanent
resident status and have had such status for at least one year. By signing
this affirmation, I swear that I have resided in the State of New York for the
past consecutive twelve months and that I have resided at the above address
and have been a resident of Dutchess County for six months immediately
prior to the date of this affirmation.
Signature:
Date:
Social Security Number: