PDFWAC 415-06-110
Adoption of form.
The director hereby adopts for use by all persons requesting inspection and/or copying or copies of the department records, the form attached hereto as Appendix A, entitled "Request for public record."
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 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 4, § 415-06-110, filed 7/27/77.]