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Forms Can Be Submitted via Email to lmecon�
olorue(�2townofwa in6,y
ern .gov or Y� I"r0���
�robinson(tc;townofwappingerny.�ov or in person/via mail to 20 Middlebush Rd Wappingers lµalls
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni I
Lori McConologue I
Grace Robinson F_
Date Received
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
❑
CODE ENFORCEMENT,
HIGHWAY
❑
RECEIVER OF TAXES
❑
RECREATION
❑
SUPERVISOR
TOWN CLERK
❑
WATER/SEWER
❑
DOG CONTROL., OFFICER ❑
TOWN ENGINEER
❑
TOWN ATTORNEY
❑
TOWN OF WAPPINGER.
1* fi u for Public Access to records
L y OIL REO Ups
Bu7Mng Department
iovrn of Wai�6�ir3 er
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
Date Applicant Contacted: 6"i1 <J- /J0j
Date FOI1,11
ullled r denied:) 1, � I
Closed by:
Date:
Notes:
Amount Due: Pages for a total of $
Name: a' ❑check here if you are
Address:' c ' requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: FAX #: ( }
Email address:
SPECIFIC DESCRIPTION OF RECORD: /
n r' 5 q-
r,
FORMAT OF RECORD (if available)
e 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
I request that the records be faxed to the number listed above