Newton Township
1528 Newton Ransom Boulevard
Newton, PA 18411

  Telephone: 570-587-1520
   Facsimile: 570-587-1674

 

RECORD REQUEST

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ADDRESS_________________________________________________

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PHONE NUMBER____________________________________________

DESCRIPTION OF RECORDS (For more space, continue on back)

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INSTRUCTIONS:     PICK-UP      FAX        MAIL         DISK


SIGNATURE (When request is fulfilled)

For Office Use Only:

Copies ______      Postage ______      Disk ______      Fax ______

TOTAL COST ________________

DATE REQUEST FULFILLED _____________________

INITIALS OF STAFF MEMBER ___________________


DATE INFORMATION: Picked up _________      Faxed _________      Mailed _________

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