Wash. Admin. Code § 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)	RequestGranted □	RecordWithheld □	RecordWithheld 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.]