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.]