Washington Administrative Code
Title 434 - Secretary of State
Chapter 434-690 - Archives - Access to public records
Section 434-690-99001 - Appendix B - Form - 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)

Request

Granted []

Record

Withheld []

Record

Withheld

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 . . . . . . .