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Forrns Can Be Submitted via Email torobinson ca ttownofwa in ern ov or
in person/via mail to 20 Middlebush Rd Wapping MMPY 12594
APR 2 1 202
FOR INTERNAL USE ONLYTown of Wappsnget TOWN OF WAPPTI GER
Tow Clerk Application for Public Access to Records
Received by: Joseph P. Paoloni FOIL EOUEST
Grace Robinson 1 .
Date Received: I
FOIL. Ser. #: c2"
DEPARTMENT:
ASSESSOR
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ACCOUNTING
❑ f
CODE ENFORCEMENT
HIGHWAY
❑
RECEIVER OF TAXES
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RECREATION
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SUPERVISOR
❑
TOWN CLERK
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WATER/SEWER
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DOG CONTROL OFFICER n
TOWN ENGINEER
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TOWN ATTORNEY
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BuMing Department
'Town of Wapp�nger
,+
FOR DEPARTMENT USE ONLY
Date:
Notes: r "
Amount Due: Pages for a total of $
Name:�r y'i 1- _ s-— . [ check here if you are
Address: f �— 5 L)s45 4, " # t (_ ; �, requesting that the records
e/ L /. „ 5 Lf be mailed to this address.
Agency or firm:
Telephone #: (q/, ) S ? - q 2x-, FAX #: ( ) -
Email address: �,Oj r tfe, = A G c' as A n L,c
SPECIFIC DESCRIPTION OF RECORD:
v 6
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FORMAT OF RECORD (if available)
HIrequest
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 be listed
request that the records sent via e-mail to the address above
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I request that the records be faxed to the number listed above