2. Name*
3. Date*
   Date
5. Address*
7. City
8. State
9. Zip Code
11. Phone Number*
12. Email Address
14. Tax Map ID #
16. I hereby apply to receive the following record(s):
    Whenever possible, please include the Tax Map ID number and property address of any parcel of land about which you are inquiring.
18. Notice: You have the right to appeal a DENIAL of this application to the Town Board of the Town of Southeast, 1360 Route 22, Brewster NY, 10509; Phone number for the Town Board is (845) 279-4313.
20. Disclaimer*

    By checking the "I agree" box below, you guarantee that any lists will not be used for commercial purposes.

    1. I agree.
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit Submit and Print

* indicates a required field