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WAC 446-20-400

Form of request to inspect record.

inspection of record request
Agency . . . .
Agency No . . . .
Date . . . .
Time . . . .
I, . . . . . . . . . . . . , request to inspect my criminal history record information maintained in the files of the above named agency.
I was born (Date of Birth) , in (Place of Birth) , and to ensure positive identification as the person in question, I am willing to submit my fingerprints in the space provided below, if required or requested.
(Fill in and check applicable box)
Because I am unable to read □; I do not understand English □; otherwise need assistance in reviewing my record □; I designate and consent that (Print Name) , whose address is . . . . . . . . . . . . . . . . , assist me in examining 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 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.]
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