Kittitas County
Request for Public Records
Date:
Name of person making request:
Address:
City:
State: Zip:
Phone:
I wish to: ____ Inspect records
____ Receive a copy of records
Request made: ____ in Person ____ by phone ____ by fax ____ by email ____ by mail
To assist us in answering your request accurately and promptly, please identify the records you wish to
inspect
by referring to a title, name, date of incident, identification number and/or description. If
copies are needed, please indicate which file(s) you would like copied. A fee may be charged for
copies that is based upon the delivery format requested. Please refer to the Fee Schedule outlined in
Kittitas County Code, Chapter 2.55
____________________________________________________
(Signature)
Please fill in and sign your name below if applicable:
I,___________________________ affirm under penalty of perjury that my request is not for commercial
purposes. This is only required if the request includes a list of individuals. I understand the use of public
records containing lists of individuals for a commercial purpose violates Washington State law and the
privacy of the individuals. “Commercial purposes” means contacting or affecting such individuals to
facilitate, in any manner, for a profit-making activity. A request for a list of individuals where this is not
signed will be denied as per RCW 42.56.070(9).
____________________________________________________
(Signature)
For County Department/Office use only:
County Department/Office: Received By:
Date action taken: Name of person taking the action:
Special Circumstances:
Email:
Delivery Method: ___Mail
___Phone ___Fax ___Email ___In Person ___Other _________________
