WAC 415-06-110. Adoption of form

The director hereby adopts for use by all persons requesting inspection and/or copying or copies of the department records, the form attached hereto as Appendix A, entitled "Request for public record." 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 . . . . 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) Request Granted □ Record Withheld □ Record Withheld In part □ (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 . . . . . . . . . For Office Use Only: (1) Request Granted □ Record Withheld □ Record Withheld In part □ (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 . . . . . . . . .