Public Record Review/Duplication Request

This request may be submitted in person, by mail, by facsimile, or e-mail to:

Borough of Dushore
216 Julia Street
P.O. Box 248
Dushore, PA 18614

Or fill out the Form below.

We would love to hear from you! Please fill out this form and we will get in touch with you shortly.

Date of Request
MM slash DD slash YYYY
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Request/Review
- Request
- Review
I (request or review) duplication of the following records. IMPORTANT: You must identify or describe the records with sufficient specificity to enable the Borough to determine which records are being requested. Use additional sheets if necessary.
I (request or review) duplication of the following records. IMPORTANT: You must identify or describe the records with sufficient specificity to enable the Borough to determine which records are being requested. Use additional sheets if necessary.
Electronic Signature*
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