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horns Can Be Submitted via Email to=.gerll or
0 OF in person/via, rnall, to 20 Middlebush. Rd Wappingers Falls NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni 11
Lori McConologue N6k'
Grace Robinson
Date Received: / /
FOIL Ser. 9: -9:Q
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RECEIVER OF TAXES
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DOG CONTROL OFFICER
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TOWN ATTORNEY
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COP"
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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Date Applicant Contacted, .-I I /
Date FOIL fulfilled or denied:
Closed. by:
Date-,
Notes:
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Amount Due, — Pa es for a total of $
Name! +hivK_ A'- Gtowavl [:]check here if you are
Address: requesting that the records
to be mailed to this address.
Agency or firm: L
Telephone: (-4) 7
FAX 4:
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SPECIFIC DESCRIPTION OF RECORD-.
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FORMAT 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
I request that the records be sent via e-mail to the address listed above