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Forms Can Be Submitted via Email t grobinson(a-),towvnofw'appingemy.gov or
in person/via mail to 20 Middlebush d Wap%malls, NY 12590
Town
Received by: Joseph P. Paoloni l
Grace Robinson i
Date Received: /
FOIL Ser. #-
DEPARTMENT:
TENT:
ASSESSOR
EI
ACCOUNTING
CODE ENFORCEMENT
HIGHWAY
0
RECEIVER OF TAXES
[�
RECREATION
❑
SUPERVISOR
D
TOWN CLERK
❑
WATER/SEWER
❑
DOG CONTROL OFFICER El
TOWN ENGINEER
❑
TOWN ATTORNEY
❑
�r• • r r " 4` •�
FOR. DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
Date Applicant Contacted:
Date 1701 fulfilledo denied:
Closed by:
Date:
Notes: upej,
Amount Due. ,m� Pages for a total of $ ,,,SD
Name: °I r) , , -1,.
Address: 4� EQ W Vu _1 C
Agency or firm:
Telephone ##:
Email address:
s,kj-fir
A)- FAX #: ( )
cheek here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESC IP ION OF RECORD:
FORMAT OF RECORD (if available) ? ; - C 5117q6, �W
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
0 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