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Forms Can Be Submitted via Email to lmcconoloLTiie(k;townofwappirjern . ov or
grol inson(i townof v�erny.gov or in person/via mail to 2.47 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Pa.oloni 1
Leri McConologue
Grace Robinson 1
Date Received:
FOIL Ser. #: (' :. -.. 4 -
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
HIGHWAY
RECEIVER OF TAXES
RECREATION
[ ]
SUPERVISOR
TOWN CLERK
WATER/SEWER
DOG CONTROL OFFICER
Q
TOWN ENGINEER
[]
TOWN ATTORNEY
S
Application for Public access to Records
FOIL REQ±' UEST
FOR DEPARTMENTUSE ONLY
Date Received by Dept Wit) Department Head approval:
Date Applicant Contacted: ' / I � /
Date FOIL fulfilled or denied: -1/17 /
Closed by:
Date: I / / �95
Notes: I- rle I n
Amount Due: Pages for a total of $
Marne: T
&'J(, o 01 a i c ❑check heref you are
I
Address: l � , requesting that the records
be mailed to this address.
Agency or firm: ccVyv
Telephone #: ( �, ) - �'1'3 FAX #:
Email address: Vay'u-V'
mvl +fiC
FORMAT OF RECORD (if available)
IH
request to be notified when I can coarse to inspect the record(s) described above
I request copies of the records described above and agree to pay the cast 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