Name of Requestor: |
Address: | Phone: |
Date of Request: | Time of Request: |
Nature of Request: |
1. Index Reference . . . . |
. . . . |
. . . . |
. . . . |
| Signature . . . . |
For Office Use Only: |
(1) | Request Granted □ | Record Withheld □ | Record Withheld In Part □ |
(2) | If withheld, name the exemption contained in RCW 42.17.310 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 . . . . . . . |
[Statutory Authority: RCW
42.17.250. WSR 91-23-024, § 434-690-99001, filed 11/12/91, effective 12/13/91.]