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) | Record Withheld In Part [] | |||||
Request Granted [] | Record Withheld [] | |||||
(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 . . . . .. | |||||
Wash. Admin. Code § 491-20-990
Order II, Appendix A (codified as WAC 491-20-990), filed 7/5/77.