Molenaer, Jeani Permit Garage.
Return to:
Name:&rliG'
(Last;) (First) MI)
Address: .�2q / 1)41)
(Street Address)
Wappingers Falls, NY 1.2590
(City) (ST) ('Lip)
Phone: ('-
Address of Sale:
(if different from above)
(street Address)
Application
Town Clerk
Town of Wappinge;r
20 Middlebush Rd.
Wappingers Falls, NY 12590
'Wap in ers Falls, NY 12590
(City)(ST) (Zip)
-1-own of Wappinger
Town Clerk
Date of Sale:Z From: Oapm) until '' (a m)
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Sign117
: r Date: 2�
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FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni 0
Grace Robinson 0
Date Received: / f
Serial #: