Name of Requestor: | |||||
Address: | Phone: | ||||
Date of Request: | Time of Request: | ||||
Nature of Request: | |||||
1. Index Reference . . . . | |||||
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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 . . . . . . . | ||||