Request for Public Records
(Pursuant to CBC’s Chapter 132S-010 WAC)
Requesting Party __________________________________________________
Date: ____/_____/____
Company or agency (if Applicable)____________________________________________________________
Address: _________________________________________________________________________________
Telephone: (____)________________
Fax (____)______________
E-mail: ______________@______
Signature: ________________________________________________________________________________
Individual named above seeks to:
1. Inspect and/or
2. Receive copy of public record of:
___________________________________________________________________________________
___________________________________________________________________________________
Identified as:
___________________________________________________________________________________
___________________________________________________________________________________
3. Is the inspection or copying of any requested public record(s) for commercial purposes? Yes No
The public records officer shall be responsible for implementing the College’s rules and regulations and regarding release of public records coordinating the staff of the
College in this regard, and generally ensuring the compliance with the public record laws under Chapter 42.56 RCW and as hereinafter amended.
Action by Public Records Officer
Date request received_________________________________
Request Granted
Department provide records ______________________________
Date Requestor notified: _______________
Subject ____________________________________________________________________________________
Inspection only Copies Requested
Number of Pages ______________
(15 cents per copy) $_________
Request not granted pursuant to Chapter 42.56 RCW (_________________________________________________________)
Reason and disposition of matter: _________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Request Completed
Copies received _________________________________________________
Requestor
Date: ______/_______/______
Date copies mailed _______________________________________________
Signature: ______________________________________________________
Date: _____/_______/_______
Public Records Officer or Designee
Rev 2 October 2016
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