Establishment Form

   Form

Word File - (establishment information form.doc)

Any Questions or Comments Please Contact Mindy S. Wessel, Environmentalist at
(812) 885-8403 Office
(812) 882-5625 Fax
(812) 890-8162 Cell

KNOX COUNTY HEALTH DEPARTMENT
520 South 7th Street, Vincennes, Indiana 47591
ESTABLISHMENT INFORMATION FORM
(Please Print or Type Clearly)