180 S. Main St., Ste. 252, Martinsville, IN 46151

765-342-6621, Fax: 765-342-1062 morgancohd@morgancountyhealth.com

Request for Disclosure of Public Records

You may print the form from here, or you may fill in the online form below.

Morgan County Health Department

Request for Disclosure of Public Records

Date:
Name:*
Address:*
Phone:*
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Fax:
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E-mail:*

Please identify the record(s) you wish to copy. Your description should be as specific as possible in order to expedite location of the record(s).

Record(s):*

Please state the reason that want to view this record. (Optional)

Reason:
By checking this box, you agree that all information included in this complaint is truthful to the best of your knowledge.*
Word Verification:

Office Use Only:Do not write below this line.

Date Request was Received:
Name of person receiving request:
Request Granted or Denied:
If denied, state reasons for denial:
Date & time of disposition: