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Forms Can Be Submitted via Email to irnccotiologue( townofwappingemy gov or
grobinsonC&,townofwappinge�oy or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni 7
Lori McConologue
Grace Robinson F
Date Received:
FOIL Ser, #: —�
DEPARTMENT:
ASSESSOR
ACCOUNTING
❑
CODE ENFORCEMENT
HIGHWAY
❑
RECEIVER OF TAXES
❑
RECREATION
❑
SUPERVISOR
❑
TOWN CLERK
WATER/SEWER
Q
DOG CONTROL OFFICER ❑
TOWN ENGINEER
Q
TOWN ATTORNEY
TOWN OF WAPPINGER
R',cation for Public Access to Records
W. ce,
Building
Towiv apartm..
Ppttr�'�b
FOR DEPARTMENT' Up' E ONLY
Date Received by Dept /
4 -
Department Head approval:
Pit)
Date Applicant Contacted: / /
Date FOIL fulfilled or denied: ! /
Closed by:
Date:
/ 3 /, S
Notes:
Amount Due: Pages for a total of
Name:'��,{, ❑cheek here if you are
Address:—'10.I-k.,c 61yw D K, (�E requesting that the records
� -'-)_ L<, d ,6" , f S,f' 0 be mailed to this address.
Agency or firm:
Telephone #: )- - FAX -
Email address:_ �-. f�
SPECIFIC DESCRIPTION OF RECORD:
.r . Mt f e"'W
A 1 i/ ' °
FORMAT OF RECORD (if available)
8 I request 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
I request that the records be sent via e-mail to the address listed above
El I request that the records be faxed to the number listed above