PDFWAC 474-01-990

Form—Request for public records.

office of state treasurer
request for public records
 
 
 
Date . . . .
 
 
 
Time . . . .
requested by:
 
 
Name . . . .
Title . . . .
Address . . . .
Telephone No. . . . .
Representing . . . .
nature of request:
 
 
. . . .
. . . .
. . . .
detailed description of document:
. . . .
. . . .
. . . .
 
 
. . . . . . . . . . . . . . . . . . . . . .
(Signature)
 
——
for office use only
——
 
(1)
Request
Granted □
Record
Withheld □
Record
Withheld
in Part □
(2)
If withheld, name the exemption contained in section 31, chapter 1, Laws of 1973, which authorizes the withholding of the record or part of the record: Subsection (1)(  ).
(3)
If withheld, briefly explain how the exemption applies to the record withheld.
(4)
If request granted, time . . . . . . . . , date . . . .
Reviewed: . . . . Public Records Officer
(Initial)
 
 
. . . .
(Initial)
Deputy or Assistant State Treasurer
[Order 2, Form (codified as WAC 474-01-990), filed 7/30/74.]