Fillable Request for Public Records (City of South Bend WA)

Fill Online, Printable, Fillable, Blank Request for Public Records (City of South Bend WA) Form

Use Fill to complete blank online CITY OF SOUTH BEND WA (WA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Request for Public Records (City of South Bend WA)

On average this form takes 4 minutes to complete

The Request for Public Records (City of South Bend WA) form is 1 page long and contains:

  • 0 signatures
  • 0 check-boxes
  • 14 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of South Bend WA

BROWSE CITY OF SOUTH BEND WA (WA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
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.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Request for Public Records (City of South Bend WA)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 16 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document