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Public Records Request Form

1006 W. Yellow Springs Fairfield Road

Fairborn, OH 45324

937-878-0611 / Fax: 937-878-9081

Requestor Information:

First Name

Last name

Email

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

Fax Number

Requested Records

#1

#2

#3

#4

#5

#6

Time Period Start

Time Period End

Cost of Duplication: $0.10 per page

Please be advised requests will be fulfilled in a timely manner and may not be available as an immediate request.

1006 Yellow Springs-Fairfield Road

Fairborn, OH 45324

Phone: (937) 878-0611

bathtwp@bathtwp.us

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