Public Records Request Online Form – Mason County Public Hospital District 2

Name(Required)

First Last

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Enter Email Confirm Email

Phone(Required)

Fax

Requested Records(Required)

Please describe what records you are looking for with names and dates if possible.

How would you like us to provide the records ?(Required)

Mail

Email (If available in electronic form)

I will pick the record(s) up at your office during regular working hours

I would like to inspect the record(s) at no charge at your office during regular working hours