Public Records Application Form

 
Board of Directors
 
Every person desiring to inspect public records of Eden Township Healthcare District shall first complete this Application for Inspection & Copying of Public Records form. Please complete all fields and click the submit button at the bottom.  If you have any questions, please contact Barbara Adranly at (510) 538-2031 ext 201.
 
Within ten (10) days of receipt of an application, the District shall determine whether the application seeks identifiable public records and whether to comply with the application.  The District shall immediately thereafter notify the person submitting the application of the District's determination and the reasons therefore.  In case of "unusual circumstances", the District may extend the ten (10) day time limit by providing written notice to the person making the application.
 
 
 
 

Today's Date *

Name *


Please enter your full legal name

Address *


City *


State *


Zip *


Phone *


Email *


Request Copy


Check here to Recieve a Copy of This Request via Email

Document Mailed Or Emailed


Does applicant wish for document to be mailed or emailed to him/her?

Inspect Record At District Office


If you answer "no" a photo copy will be mailed to you.  Photocopies are $0.25 per page.

Requested Inspection Date

Please enter your requested date for the inspection

Description of Records *


Please enter a detailed description of the records you would like to inspect.   Please be as specific as possible.
 

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