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FOR INTERNAL USE ONLY Town of Wappinger
Agreement for the Use of the Town
Hall Facilities for Meetings
2010-01-19 JCM
Date Received:
Chris Masterson 0
Christine Fulton ~ /
Sue Rose ~
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Received by:
Serial #:
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Agreement for the Use of the Town Hall Facilities for Meetings
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Na e of Organizatio or Group
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Phone No.
This will confirm the arrangements being requested for your groups' use ofthe Wappinger Town Hall Facilities, as
noted below:
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Senior Citizens Room
Large Meeting Roo~ .
Other: Specify: \!o u et
The group is not expected to exceed J!r persons
Date(s): 11 I () I b2 6- f) 9 30
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Time: f',~olvJrl I Y:ooprn
It should be understood that groups using the Buildings' Facilities for evening meetings must select dates when
Town Meetings are normally scheduled (i.e., Justice Court, Planning Board, etc.) Special requests will be
considered upon their own merit, and arrangements can be made for access to, and closing, the building at the close
of your meeting.
You and your Organization hereby agree to adhere to the rules set forth on the attached page by signature of an
authorized member of your Organization or group.
The Town of Wappinger reserves the right to suspend temporarily this agreement should the Town have need of the
facility for its own purposes. Advance notice will be given as soon as possible on such occasions.
The Town Clerk should be informed promptly of any schedule change or cancellation of your group activities.
Arrangements for access to specific area to be used should be made with the Town Clerk at the time this form is
submitted.
No application shall be considered approved until it has been submitted to the Town Clerk for review and
Clearance.
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2010-01-19 JCM
Terms of the agreement must be strictly adhered to by the contracting group as any disregard or abuse of the rules
for use of the facilities will result in termination of use by the offending group, and they will not be granted
reinstatement.
I have read and understand the rules and regulations for the use of the Facilities in the Town of Wappinger Town
Hall, and will comply with these requirements.
Signed: . a Q t;/ ~/tl. -
For:
(Name of Group or Organization)
Date:
Date: eX J OJ 3 ~I 0
Approved: .>
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Feb 23 10 09:37a
US Census POK LCO 2139
1 8458783476
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UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. Census Bureau
Washirlg1on, DC 20233-0001
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Thank you for donating the space identified below for use in testing/training U.S.
census workers.
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We understand that we can use this space (rent free) lor the period(s) indicated
above. If this is not correct, please let us know.
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Copy distribution: WHITE - Donor
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USCENSUSBUREAU
Helping Yau .\.fake !n.fo,rmed Declsrcl!! \'\"\\1Yt'.census.go\!
G:x)" ').5 GOVERNMENT PRlNTlIolG QF=ICE: 201]9-541-22J
2010-01-19 JCM
Rules For Use Of Town Hall Facilities For Group Meetin2s
1) Using Group assumes responsibility for any damage to furnishings, equipment, or property.
2) Food, beverages, and paper products, if used, will be provided by using group.
3) Group using Senior Citizen Room shall not use the TV, Kitchen, or Kitchen equipment andlor
Senior Citizen provisions.
4) No food or beverages are to be furnished and lor served when using the Large Meeting Room.
5) Using group agrees to restore tables, chairs, etc. to places where found at beginning of session,
clean tables and discard rubbish, if applicable.
6) Groups using Senior Citizen Room will close and lock windows and doors and turn off lights at
end of each session.
7) Strict adherence to: "NO SMOKING" regulations must be observed.
Feb 2310 09:38a
US Census POK LCO 2139
18458783476
p.1
I UNITED STATES DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. Census Bureau
I Poughkeepsie Local Census OffICe
31 Route 22 Suite 6
Pawling, NY 12554-3219
February 23,2010
Town of Wappinger
20 Middlebush Rd.
Wappinger, NY 12590
Dear Ms. Rose.
The Government is self-insured and does not maintain general liability insurance. Census agrees
to promptly consider and adjudicate any and all claims which may arise out of use of subject donator's
premises resulting from the actions of Census or duly authorized representatives or contractors of
Census and to pay for any damage or injury as required bV Federal law. Such adjudication will be made
pursuant to the Federal Tort Claims Act, 28 U.S.c. 2671 et. seq. or such other legal authority as may be
pertinent.
Census also agrees to consider and adjudicate any claims for damage or inj ury sustained by
Census personnel in the performance of their official duties. Such Adjudication will be made pursuant to
the Federar Employees Compensation Act. 5 U.S.c. 8101 et.seq. or other such legal authority as may be
pertinent.
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David Fracasso
Office Operations Supervisor
U.S. Census Bureau, Poughkeepsie N.Y. Office
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Sending Confirm
Date FEB-23-2010 TUE 10:45AM
Name TOWN CLERK
Tel. (845)298-1478
Phone
Pages
Start Time
Elapsed Time
Mode
Resu 1t
8783476
6
02-23 10:42AM
02 I 00"
ECM
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TOWN CLERK
Chris Masterson
TOWN OF WAPPINGER
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TOWN SUPERVISOR
Christopher J. Colsey
.
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
WWW.TOWNOFWAPPINGER.US
(845) 297-4158. Main
(845) 297-5771 - Direct
(845) 298-1478 - Fax
TOWN BOARD
William H, Beale
Vincent Bettina
lsmay Czarniecki
Joseph P. Paoloni
Office of the Town Clerk
The Following Fax Message Consists of
Including Cover Sheet
(0
Pages
FAX TELEPHONE NUMBER (845) 298-1478
DATE:
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REFERENCE:
IF YOU DO NOT RECEIVE ALL THE PAGES, PLEASE CONTACT
SENDER IMMEDIATELY.
Sender: