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Forms Can Be Submitted via Email to grobiiison(�to nofwapt)ingeniy.gov or
in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12594
FOR INTERNAL USE ONLY
Received by: Joseph P Paoloni I
Grace Robinson I 1
Lisa Patterson L
Date Received:
FOIL., Ser. #:
DEPARTMENT:
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ASSESSOR
ACCOUNTING
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CODE ENFORCEMENT
Closed by:
HIGHWAY
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RECEIVER OF TAXES
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RECREATION
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I request copies of the records described above and agree to pay the cost of such records in.
SUPERVISOR,,
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a total of
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DOG CONTROL OFFICER
TOWN ENGINEER
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TOWN ATTORNEY
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Town Clerk
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OR DEPARTMENT USE ONLY
Date Received by Dept
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Department Head approval:
Date Applicant Contacted:
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Date FOIL fulfilled or denied: / / _
Closed by:
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Date:
FORMAT OF RECORD (if available)
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I request copies of the records described above and agree to pay the cost of such records in.
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Amount Due: Pages for
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a total of
Name: �- � °� 'C & �00 0_ check here if you are
Address: ry, 4 --qv -,A 9 - requesting that the records
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Agency or firm:
Telephone : ( t 1�;) , _ 1 ;, FAX-
Erriarl address: -e- - -CZ
SPECIFIC DESCRIPTION OF RECORD:
FORMAT OF RECORD (if available)
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