REV 08/11/11
Weber County Operations Division
2380 Washington Blvd., Suite 240
Ogden, UT 84401-1456
(801) 399-8374 or 801-399-8791
Fax (801) 399-8862
Requestor’s Name: Daytime Phone:
# and Street City State Zip
Clear description of record sought:
I would like to view/inspect the record
I would like to receive copies of the record. I understand that Weber County may charge a reasonable fee for
copies or records and/or staff time, for packaging, summarizing, etc. (§63-2-203, Fees), and that copies will be
provided subject to fees being paid. I authorize costs of up to $ . If costs are greater than the amount
I have specified, I further understand that the office will contact me for approval prior to processing the req
Requestor’sSignature: Date:  ___________________
For Staff Use
Request Accepted By: Date:
Request Approved By: Date:
Staff Comments:
Requestor was notified that this office does not maintain the requested record(s), and if known was also
notified of the department that maintains the record. The request was forwarded to
department for processing on: Date:
Extension of time for extraordinary circumstances. Required notice sent on: Date: ____________ _______
Cost authorization obtained from requestor on: Date: ___________________ .
Cost: $ Receipt No. Fees Collected By:
Record(s) Received By: Date:
Staff Comments:
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