Wash. Admin. Code § 491-20-990
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) | RecordWithheldIn Part □ | ||
| RequestGranted □ | RecordWithheld □ | ||
| (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.]