Fillable GRAMA-Request-Form GRAMA Request Form

Fill Online, Printable, Fillable, Blank GRAMA-Request-Form GRAMA Request Form Form

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GRAMA-Request-Form GRAMA Request Form

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The GRAMA-Request-Form GRAMA Request Form form is 3 pages long and contains:

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  • 28 check-boxes
  • 27 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Heber City Corporation

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GRAMA Request Form
Note: Utah Code § 63G-2-204 (GRAMA) requires a person making a records request furnish the governmental entity
with a written request containing the requester’s name, mailing address, daytime telephone number (if available); and a
description of the record requested that identifies the record with reasonable specificity.
Requester’s information
Name:
Address:
City/State/zip:
Daytime telephone number:
Request made to
Government agency or office:
Address:
City/State/zip:
Records requested
Note: The more specific and narrow the request, the easier it will be for an agency or office to respond to the request. If
you are unsure about the records’ description, contact the agency or office records officer.
Note: Government keeps records in “series” or groups of records. To find out what series an agency or office maintains,
visit the Archives’ website, http://archives.utah.gov
. The record series retention schedules on the Archives’ website
include relevant descriptions.
Title or series number of records (if known):
Description of records including all relevant information—location of event(s) described in records, city,
county, address; date range of the records; names of the person(s); and subject of the request.
Details about th
e requester
Date:
Office of the Government Records Ombudsman
Utah State Archives
http://archives.utah.gov/opengovernment/ombudsman.html
GRAMA Request Form
Page 1 of 3
Note: If the record has a restricted access, GRAMA provides that certain individuals may still receive access.
I am the subject of the record
I am the authorized representative of the subject of the record
I provided the information in the record
Considerations about the desired response
I would like to:
View or inspect the records only
Receive a copy of the records and pay associated fees. Please notify me if the amount will exceed
$
Receive a copy of the records and request a fee waiver, according to Utah Code § 63G-2-203, because:
Releasing the record primarily benefits the public
I am the subject, or authorized representative, of the record
My legal rights are directly implicated by the information of the record because
, and I am impecunious
Receive an expedited response (5 days) because releasing the record benefits the public; I request the
information for a story or report for publication or broadcast to the general public
http://archives.utah.gov/opengovernment/ombudsman.html
GRAMA Request Form
Page 2 of 3
Office of the Government Records Ombudsman
Utah State Archives
Agency use only
Date request received: Time limit for response:
Classification of records (check all that apply):
Public, records provided (date)
Private, legal citation § § 63G-2-302 or 303
Controlled, legal citation § 63G-2-304
Protected, legal citation § 63G-2-305
Governed by court rule, another state statute, federal statute, or federal regulation
No
t a record
Disclosure of restricted records:
Is access authorized?
Private: Requester is the subject of the record
Requester is authorized pursuant to Utah Code § 63G-2-202(1) and has supplied
required documentation
Requester is not authorized to have access
Controlled: Requester is authorized pursuant to Utah Code § 63G-2-202(2) and has supplied
required documentation
Requester is not authorized to have access
Protected: Requester submitted the record
Requester is authorized pursuant Utah Code § 63G-2-202(4) and has supplied
required documentation
Requester is not authorized to have access
Identification provided:
Response:
Approved, requester notified on
Denied, written denial sent on
Requester notified agency does not maintain record on
Extraordinary circumstances invoked, legal citation
Consequent arrangements and time limits
Fee:
If waived, fee waiver approved by:
Note: Please refer to GRAMA Classification form and GRAMA Fee form for assistance. If access to
records is denied in part or in whole, please use the GRAMA Notice of Denial form.
http://archives.utah.gov/opengovernment/ombudsman.html
GRAMA Request Form
Page 3 of 3
Office of the Government Records Ombudsman
Utah State Archives
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GRAMA-Request-Form GRAMA Request Form

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Completed 12 July 2020

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