Wash. Admin. Code § 446-20-400
inspection of record request
(RCW 10.97.080/WAC 446-20-070)
| 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 fingerstaken simultaneously | (Signature or markof 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.]