West Windsor Fire Company, Inc. Jerryl Launt, Chief John West, President 9Karla Drive Windsor, N.Y. 13865 Windsor Town Board 124 Main. Street Windsor, N.Y. 13865 28-Aug-23 Date RECEIVED 3027.5823 OFFICL OET WIMDSOILIY THETVENICLERK Thej following person has applied fori membership in the West Windsor Fire Company. Having been cleared throuhg Broome County Office of Emergency Services, please confirm or reject the applicant listed below and return the bottom portion of this form. Applicant Name Boerner Jamie First B Middle Initia! Last 226 Springer Rd. Street Binghamton Town Phone 8/11/1994 Date of Birth S.S.# 15-Aug-23 NY State 13904 Zip BROOME COUNTY, EMPLOYEE HEALTH. SYSTEM PHYSICAL Clearance through Broome County OES Chief Cut Here Name of Applicant Boerner, Jamie Accepted Denied Date Return To: Windsor Town Clerk West Windsor Fire Company Inc. 9 Karla Drive Windsor, N.Y. 13865 Revised 1-4-2022