PDFWAC 434-690-99001

Appendix B—Form—Request for public records.

appendix b
request for public records
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.]