Appendix A—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) | | Record Withheld In Part □ |
| | Request Granted □ | Record Withheld □ |
(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 II, Appendix A (codified as WAC 491-20-990), filed 7/5/77.]