PDFWAC 210-06-990
Appendix A—Form—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) | Request Granted □ | Record Withheld □ | Record Withheld In Part □ |
(2) | If withheld, name the exemption contained in § 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 XII, Form (codified as WAC 210-06-990), filed 11/28/73.]