Request for Public Records
Please describe the records below, providing any additional information that will help us locate them for you as quickly
as possible. Use appropriate document titles and dates, if known.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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Do you want to?
Inspect the records at no charge
Receive a copy after paying required fee
Inspect the records first and then consider selecting records to copy and pay for
Within five business days of receipt of the request, the City will respond by: (1) making the record available for
inspection or copying, or, if payment is made or terms of payment are agreed upon, sending the records to the requestor;
or (2) acknowledging the receipt of the request and providing a reasonable estimate of time the City will require to
respond to the request; or (3) denying the request.
Washington State Law, RCW 42.56.270 prohibits the use of lists of individuals for commercial purposes. If I or
someone else uses these records for commercial purposes I may violate the rights of the individuals named and I may be
liable for damages. “Commercial purposes” means that the person requesting the records intends that the list will be
used to communicate with the individuals named in the record for the purpose of facilitating profit-expecting activity.
I certify that the lists of individuals obtained through this request for public records will not be used for commercial
purposes
Dated this _________ day of _________________, 20 ____.
______________________________________
Name
______________________________________
Address
______________________________________
City, State, Zip
______________________________________
Email (optional)
-See Next Page for Fee Schedule and Response to Request-
Submit
Request Granted
Date Request Received _____________________________
Date Completed ___________________
Number of 8 ½ x 11 B & W Pages ____________ x .15 =
$
Number of 8 ½ x 11 Colored Pages ____________ x .25 =
$
All Other Sized Pages_______________________ x .25 =
$
Document Fee ___________________________________ +
$
Staff Time w/Benefits _____________________________ +
$
Other Media Fee _________________________________ +
$
TOTAL CHARGE
$
For Department Use Only
Request Denied
Date Request Received _____________________________
Date Completed ___________________
The City is refusing to allow inspection or copying of the requested documents described on the reverse
side of this request form. Access to the requested public records is denied for the reason that it is clearly
non-disclosable as identified in RCW 42.56 or certain portions have been withheld pursuant to RCW
42.56.
Following is a brief explanation of how the exemption applies to the record(s) withheld:
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_____________________________________________________________________________________
_____________________________________________________________________________________
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Withholding of the specific portions of the public record, which the City is not disclosing to you, is an
authorized exemption.
For Department Use Only
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