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Forrns Can Be Submitted via Email to grobinson tt�townofwa in >ern ov or
in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
11 Received
Received by: Joseph P. Paolon:i -1
Grace Robinson A 2 1 2
Date Received:
FOIL Ser. #:
M " r
Town of Wappl ger
Town Cler
ASSESSOR
Name: " GAS .-- check here if you are
ACCOUNTING
Address: requesting that the records
1.21-3 3 be mailed to this address.
CODE ENFORCEMENT
Agency or firm:
HIGHWAY
Telephone #: (S;Vs ) 6L_94 - pj p.3 FAX #: ( ) -
Email address: �/",I-1,r , com,--
RECEIVER OF TAXES
❑
RECREATION
❑
SUPERVISOR
TOWN CLERK
WATER/SEWER
❑
DOG CONTROL OFFICER Ej
TOWN ENGINEER
El
TOWN ATTORNEY
❑
"TOWN OF WAPPIN ER
Application for Public Access to Records
.FML REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept /
Department Head approval:
Date Applicant Contacted: �4_ / I
Date FOIL fulfilled or denied: / /9�0_
Closed by:
Date:
Notes: ar ,/
'f / 20 /
Amount Due: j Pages for a total of .
Name: " GAS .-- check here if you are
Address: requesting that the records
1.21-3 3 be mailed to this address.
Agency or firm:
Telephone #: (S;Vs ) 6L_94 - pj p.3 FAX #: ( ) -
Email address: �/",I-1,r , com,--
SPECIFIC DESCRIPTION OF REC Ry:
,.
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 request that the records be sent via e-mail to the address listed above
1 request that the records be faxed to the number listed above