REQUEST FOR DISCLOSURE OF PUBLIC RECORDS
DATE OF REQUEST
NAME E-MAIL
ADDRESS
CITY STATE ZIP PHONE
I am requesting the records described below. (Please provide any additional information that will help us locate
the records. Use appropriate document title and date, if known. Please print clearly.)
Within five (5) business days after receiving a request, this agency will either:
1. Provide the record (s);
2. Acknowledge your request and give you a reasonable estimate of how long it will take to respond;
3. Deny your request in writing, with reasons for denial. The City will tell you the specific exemption or other law it relies upon for the denial.
Lists for Commercial Purposes
Washington State law, RCW 42.56.070(9), prohibits the City from providing access to lists of individuals
requested for commercial purposes. “Commercial purposes” means that the requestor requesting such
information from the public records of the City intends to use the information to contact or in some way
personally affect the individuals identified on the list and when the purpose of the contact would be to facilitate
the requestor’s commercial activities.
I hereby declare, under penalty of perjury under the laws of the State of Washington, that the list
of individuals I have requested from the City of DuPont under this request for public records will
not be used for commercial purposes.
Signed at __________________, Washington, this _________ day of _____________________, _______.
______________________________________________________
Signature of Requestor
CITY OF DuPONT
1700 Civic Drive • DuPont, WA 98327
Phone (253) 964-8121 • Fax (253) 964-3554
www.dupontwa.gov
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