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WAC 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.]
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