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Forms Can Be Submitted via Email to InncconolOgLie(Li,,,townofwapping,-_i:p . Dov or
grobinson(�i:townofwa Nngerny. ov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR MTL RNAL USE ONLY
Received by: Joseph P. Paoloni
Lori McConologue
Grace Robinson _I
Date Received:
FOIL Ser, #t: �-
DEPARTMENT:
ASSESSOR]
ACCOUNTING
CGDE ENFORCEMENT
HIGHWAY
RECEIVER OF TAXES
RECREATION
SUPERVISOR
TOWN CLERK
WATE RISEWER
DOG CONTROL OFFICER,
TOWN ENGINEER
❑
TOWN ATTORNEY
❑
Name:
Address:
TOWN OF'WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept 7 I1
Department Head approval:
Date Applicant Contacted: / LL I " 5
Date FOLL Fulfilled or denied: I L1/ :
Closed by:
Date: I 1
Notes:
Amount Due:
Pages fora total of $ q n 43..,
[]check here if you are
requesting that the records
be mailed to this address.
Agency or firm:
Telephone � P; _ ,�� ry � r r ;'' �..� ° �"
Email address: �r� ,... �- c c d'✓33 �'�u
SPECIFIC DES R.IPTION OF RECORD:
IS CL
615S- 0(4- (/
FOF-MAT OF RECORD (if available)
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..
ElI request that the records be sent via e-mail to the address listed above