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Public Records Review/Duplication Request
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Date of Request:
*
Date of Request:
First Name
Last Name
Address1
Address2
City
State
Zip
Telephone No.
I request (check applicable boxes) of the following records:
*
Review
Duplication
Requested information to be:
*
Picked-up
Faxed
Mailed
E-mailed
E-mail address
Fax No.
Important: You must identify or describe the records with sufficient specificity to enable the Township to determine which records are being requested.
*
I certify that I am a legal resident of the United States of America:
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No
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