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194TOWN CLERK Christine Fulton 20 MIDDLEBUSFI ROAD WAPPINGERS FALLS, NY ]2590 WW W.TOWNOFWAPPINGER.US (845) 297-4158 -Main (845) 297-5771 -Direct (845) 298-1478 -Fax Office of the Town Clerk TOWN OF WAPPINGER FOIL CERTIFICATION FORM STATE OF NEW YORK: COUNTY OF DUTCHESS: SUPERVISOR Barbara A. Gutzler TOWN BOARD William H. Beale Vincent Bettina Ismay Czarnieclci Michael Kuzmicz Pursuant to FOIL Law §89.3 A, I ~-yL1 L- to r t C n~1q~,~ ~~ Tt- ~~-'°' certify I will not use L~ r I"` lists of names and addresses for solicitation or fund-raising urposes and will not sell, give or otherwise make available such lists of names and addresses to any other person for the purpose of allowing that person to use such lists of names and addresses for solicitation or fund-raising purposes. Dated: Wappingers Falls, NY October ~, 2012 ~/ ~._ " Swo before me this ~i~ day of October, 2012 ~° -; Christine Fulton Town Clerk