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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.]
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