form updated 6/17/21
City of Duvall
15535 Main Street NE
PO Box 1300
● Duvall, WA 98019
425-788-1185
● FAX 425-788-8097
www.duvallwa.gov
City Action Request Form
Please fill out this form completely and be as specific as possible, providing location, dates, times, etc.
SECTION 1 – TO BE COMPLETED BY REQUESTING PARTY
Name: Representing: Daytime Telephone #:
Mailing Address: Email:
City, State, Zip: Preferred method of communication regarding
this request:
Email Telephone
**All documents sent to the City of Duvall are public records and are subject to disclosure under to the Public Records Act
(RCW 42.56). The City may be required to release your name and/or information pursuant to RCW 42.56 or a court order.
You, as the complainant, victim, or witness, may request nondisclosure of your identifying information if you qualify under
RCW 42.56.240(2).
Yes, I request that my identifying information not be disclosed
Location of Requested Action:
Detailed description of request or comment (be as specific as possible)
Requested Action, if any:
Do you want staff to contact you? : Yes No
(If yes, please indicate your preferred method of communication above)
SECTION 2 – FOR CITY USE ONLY
Received by: Forwarded to:
