Freedom Of Information Act (FOIA) Request

If needed, please visit our website at barryeatonhealth.org to see the FOIA Public Summary document for the FOIA requesting procedure.

Requesting Record For:
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
County *
Township *
Section number
Tax ID #:
Owner Name Owner Name First Last
Requesting period of records from: Requesting period of records from: * / MM / DD YYYY
Requesting period of records to: Requesting period of records to: * / MM / DD YYYY
Specific records requested *

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Requestor Information

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Name of Requestor Name of Requestor * First Last
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Representing *
If "Other" above, please describe:
Your Email *
Preferred method of receiving FOIA request response: *
If Requesting via Fax above, please provide your fax number:
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