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Forms Can Be Submitted via Email to grobinson0atowpofwEpingEny.go or
in person/via mail to 20 Middlebush Rd A%ppWy@A Falls, NY 12590
FOR INTERNAL USE 0 \Nappir ger TOWN OF WAPPINGER
Town Clerk ublic Access to Records
Received by: Joseph P. Paoloni F]
ir
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Grace Robinson 0 VEST
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
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ACCOUNTING
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CODE ENFORCEMENT
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HIGHWAY
El
RECErVER. OF TAXES
El
RECREATION
SUPERVISOR
TOWN CLERK
WATER/SEWER
DOG CONTROL OFFICER 0
TOWN ENGINEER
1:1
TOWN ATTORNEY
1:1
Name:
Address:
MAS
FOR DEPARTMENT USE ONLY
Date Received by Dept S/
Department Head approval- ri
Date Applicant Contacted: 45- / I S/ Z) (a
Date FOIL fulfilled or denied: EL/I&
Closed by:
Date:
Notes: de J nok? 4-6-41
Amount u�e- �Pagesfora�totalof $�—
check here if you are
requesting that the records
Wv be mailed to this address.
Agency or fmn: 'i� eCA
..... .. . . ....
Telephone #: FAX 4:
Email address- 7,,)acjf-
SPECIFIC DESCRIPTION OF RECORD:
4 -
FORMAT OF RECORD (if available)
Irequest to be notified when l, can come to inspect the records) 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