PDFWAC 491-20-990

Appendix A—Request for public records.

appendix a
request for public records
Name of Requestor:
Address:
Phone:
Date of Request:
Time of Request:
Nature of Request:
1. Index Reference. . . .
2. If not identifiable by reference to the index, then describe the document(s) in detail. . . .
. . . .
. . . .
 
Signature. . . .
For Office Use Only:
(1)
 
Record
Withheld
In Part □
 
 
Request
Granted □
Record
Withheld □
(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 record: Subsection (1) ( ).
(3)
If withheld, briefly explain how the exemption applies to the record withheld.
(4)
If request granted, time . . . . ., day . . . . ..
[Order II, Appendix A (codified as WAC 491-20-990), filed 7/5/77.]