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Forms Can Be Submitted via Email to InicconologueJ'rito tnc i' ap , n e ny. civ or
i,yrobinson(d,)tc)wnofNvappinrerny. or in person/via snail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni -1
Lori. McConologue Tow
Grace Robinson
.Date Received: /
FOIL Ser. #: � —U H
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
❑
CODE ENFORCEMENT
❑
HIGHWAY
❑
RECEIVER OF TAXES
❑
RECREATION
❑
SUPERVISOR
❑
"T"OWN CLERK
I request copies of the records described above and agree to pay the cost of such records in
WATER/SEWER
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
DOG CONTROL OFFICER ❑
TOWN ENGINEER
❑,
TOWN ATTORNEY
❑
.SEP 0 9 12),?WN OF WAPPING
ER
;.
ation for Public Access to Records
of Wapping�691LREOUEST
own Clerk ._.
FOR DEPARTMENT USE ONLY
Date Received by Dept/ /
Department Head approval:
inrt)
Date Applicant Contacted: I 1
Date FOIL fulfilled or denied: / /a
Closed by:
Date: ❑ l l
Notes:
Amount Due: —Pages fora total of $
Name: ( C; l) e [,check here if you are
Address: requesting that the records
be mailed to this address.
Agency or firm: v hq e rs
Telephone ##:( } FAX
Email address: f f
SPECIFIC DESCRIPTION OF RECORD:
FORMAT OF RECORD (if available)
HIrequest
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
1 request that the records be faxed to the number listed above