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Forms Can Be Submitted via Email to Imcconolo ue(a)townofwa in Fern ov or
grobins on(&townofwappingerny ov or in person/via'I to 20 Middlebush Rd Wappingers Falls, NY 12590
eC 'i'1 e
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni I TO
Lori McConologue I
Grace Robinson =1
Date Received:
FOIL Ser. ##: ai`
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
❑
CODE ENFORCEMENT
HIGHWAY
RECEIVER OF TAXES
RECREATION
SUPERVISOR
0
TOWN CLERK
WATER/SEWER
DOG CONTROL OFFICER
❑
TOWN ENGINEER
[]
TOWN ATTORNEY
❑
Name: zl/" )
Address:
M
FOR DEPARTMENT USE ONLY
Date Received by Dept/ / 9
Department Head approval: iV
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Date Applicant Contacted: C /9 / 5
Date FOIL fulfilled or denied: / /
Closed by: r r"
Date: 1 I
Notes: ,r' � Is".75 c7t
Amount Due: — Pages fora total of $
Agency or firm;
Telephone #: FAX ##:
Email address:
❑check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
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JA
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FORMAT OF RECORD (if available)
IH
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