Requests for public records can be mailed, emailed,
faxed, or hand-delivered.
Mailing Address: ______________________________________________________________________________
City: ______________________________________________ State: ____________ ZIP: __________________
Phone Number: ____________________________________ E-mail: ____________________________________
RECORDS REQUESTED: Please describe the identifiable records you are requesting and any additional information
that will help us locate said records (dates, names, parcel #, etc.) RCW 42.56.520 requires a response within five (5) business
Desired format of records requested: □ paper □ electronic
I understand that Washington State Law (RCW 42.56.070(8)) prohibits the use of lists of individuals for commercial purposes. I
understand that “commercial purposes” means that the list will be used for the purpose of facilitating profit-expecting activity. I
hereby declare under penalty of perjury pursuant to the laws of the State of Washington that I will not use any list of individuals
obtained from this request for commercial purposes. I also acknowledge that I am solely responsible for any consequences or
damages arising from my commercial use of any list of individuals I am obtaining.
Signature: _______________________________ Date: _________________ City/State where signed: ______________________
FOR OFFICIAL USE ONLY
Date received: ___________________ Received by: _______________________________________________
Request received □ in person □ telephone □ fax □ email □ letter Date response required: _____________________
Request forwarded to: _________________________________________ Date forwarded: _________________
□ Approved; request fulfilled. Notified Requestor records are available and where. If copies requested and payment or deposit
on payment has been made: copies sent.
□ Fulfilled via: □ paper copies (over the counter) □ email □ other (specify): ___________________________________
□ No responsive records. Notified Requestor.
□ Request to be denied; IMMEDIATELY forward to Prosecuting Attorney for review.
□ Record partially withheld. Notified Requestor with reason for partial withholding listing exemption(s) cited. Copy of letter
□ Legal review required. Estimate _______ days needed for final response. Notified Requestor. Copy of letter attached.
□ Clarification needed from Requestor. Contacted for clarification & notified of revised estimate of when records will be
available. Copy of letter attached.
□ DENIAL APPROVED: Requestor to be notified by mail of reasons for denial.
Signature: _________________________________________________ Date: _____________________________________
REQUEST # ______________________________
For Official Use Only
Name & Department/Office
Employee is required to sign if completed on behalf of the requestor and the requestor chose not to sign or is unable to sign
Signature: ________________________________ Date: _________________ City/State where signed: ______________________