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Forms Can Be Submitted via Email
grobi n sonL�4to wriofivapp ingerriv. go,v or in person/via mail to 20 M iddlebush Rd W pingers,2,
Falls,, N,.Y,
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni -
Lori McConologue -
Grace Robinson -
Date Received:
FOIL Ser. 4:
1701FIEVOITIMIM
Zo -y-W,1
ASSESSOR
11
ACCOUNTING
F-1
CODE ENFORCEMENT
HIGHWAY
M
RECEIVER OF TAXES
0
RECREATION
❑
SUPERVISOR
❑
TOWN r CLERK
M
WATER/SEWER
❑
DOG CONTROL OFFICER
TOWN ENGINEER
TOWN ATTORNEY
❑
Name:
Address. -
Agency or firm: VCA
Telephone 9:
Email address: --)k(;.t
I I to] A AA 12 Kel
DFrE " ublic Access to Records
REOUEST
BuRding Department
TOWN OF WAPPINGE
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval
Date Applicant Contacted-.
Date FOIL fulfilled or denied
Closed by:
_LL/ 1!
vit)3
Date: LL / 19 / -0-5
Notes: Id
Amount Due: Pages for a total of
e a Dcheck here if you are
:D L-flaiv (,L'n-' requesting that the records
i J I i f\ I U 125Q b be mailed to this address.
FAX 9
SPE IFI DESCRITON OF RECORD:
6n s( 2— o,?- (-73L( qO'��
FOR -MAT OF RECORD (if available)
Irequest 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
IH 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