Form of request to inspect record.
inspection of record request
Agency . . . . |
Agency No . . . . |
Date . . . . |
Time . . . . |
I, . . . . . . . . . . . . , do hereby request to inspect my criminal history record information maintained in the files of the above named agency. In order to ensure positive identification as the person in question, I am submitting my fingerprints in the space below. |
(Fill in where applicable box) |
Because I am unable to read □; do not understand English □; other reason □; I hereby designate and consent that (Print Name) , whose address is . . . . . . . . . . . . . . . . , read or otherwise described or translated to me the criminal history record information concerning myself. |
. . . . . . . . |
Prints of right four fingers taken simultaneously | (Signature or mark of Applicant) . . . . |
| (Address) . . . . |
| . . . . (Signature of Designee) |
[Statutory Authority: Chapters
10.97 and
43.43 RCW. WSR 21-05-044, § 446-20-400, filed 2/11/21, effective 3/14/21; WSR 10-01-109, § 446-20-400, filed 12/17/09, effective 1/17/10. Statutory Authority: RCW
10.97.080 and
10.97.090. WSR 80-08-057 (Order 80-2), § 446-20-400, filed 7/1/80.]