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Forms Can Be Submitted via Email to IMCC011010gLie Lwtownofwappingerny.gov or
grobin son (c�townofwappi n gerny gov or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni —
Lori McConolo�ue —
Grace Robinson
Date Received:
FOIL Ser, 4:
DEPARTMENT:
ASSESSOR
ACCOUNTING
❑
CODE ENFORCEMENT
HIGHWAY
❑
RECEIVER OF TAXES
El
RECREATION
❑
SUPERVISOR
TOWN CLERK
❑
WATER/SEWER
❑
DOG CONTROL OFFICER ❑
TOWN ENGINEER
TOWN ATTORNEY
TOWN OF WAPPfNGER
Application for Public Access to Records
OIL REOUEST
F-- E FOil Received
,3,,-,j,j'jng DePa,tnent
I'O\Nn of WaLping
er
of Vvappinger
;awn (,',Ierk
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval
Date Applicant Contacted:
]j
denied
Date 17011_4(�ilf�i n'ed
Closed by:
Date:
Notes: CJ
Amount Due: Pages for a total of S_
Nance: Fjcheck here if you are
Address: 't requesting that the records
be mailed to this address.
Agency or firm:
Telephone 4: <) j FAX 9:
Email address:
SPECIFIC DESCRIPTION OF RECORD:
FORMAT OF RECORD (if available) CIN
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
H Z:' .
accordance with the fee schedule on the back of this application
Irequest that the records be sent via e-mail to the address listed above
H I request that the records be faxed to the number listed above