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Forms Can Be Submitted via Email to grobinson (&,townofwappingery.gov or
in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAI SLY
Received by: .Joseph P. Paoloni I
Grace R"s rD 20N
Town oat Wappinge'r
Town Clerk
Date Received:
FOIL Ser. #I:
ASSESSOR
ACCOUNTFNG
CODE ENFORCEMENT
HIGHWAY
❑
RECEIVER OF TAXES
❑
RECREATION
E]
SUPERVISOR
TOWN CLERK
El
WATER/SEWER
❑
DOG CONTROL OFFICER ❑
TOWN ENGINEER
❑
TOWN ATTORNEY
❑
A
A{■ - i.
MAY 1120 6
a
uMng Dep rtriel
TOWN CSP WAPPING
FOR DEPARTMENT USE ONLY
Date Received by Dept / 11 /
Department Head approval:
�inrt)
Date Applicant Contacted: 7' / � � I
Date FOIL fulfilled or denied: 6 /1 � /
Closed by:
Date:
Notes: V I,n 04_1'
Amount Due: Pages for a total of $ ,
Name; 0" o., F-1 check here if you are
Address: `2- c � 5d„ PL requesting that the records
W�,\4"` r ._(�J S a f z G be mailed to this address.
Agency or firm:
Telephone ##: (S'�5
Email address:, -To,-
)
ddress:,-o
)- a FAX #: ( )
M 7 z , c o,
SPECIFIC DESCRIPTION OF RECORD:
54.J1 Ll e l Z a
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