Fillable STEVENS COUNTY PUBLIC RECORDS REQUEST FORM (Stevens County)

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STEVENS COUNTY PUBLIC RECORDS REQUEST FORM (Stevens County)

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The STEVENS COUNTY PUBLIC RECORDS REQUEST FORM (Stevens County) form is 1 page long and contains:

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  • 18 check-boxes
  • 20 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Stevens County

BROWSE STEVENS COUNTY (WA) FORMS

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STEVENS COUNTY
PUBLIC RECORDS REQUEST FORM
R
EQUESTERS NAME/TITLE:___________________________________________________________
ADDRESS___________________________________________________________________________
PHONE NUMBER______________________ E-MAIL_______________________________________
F
ORMAT YOU WOULD PREFER THE RECORDS TO BE PROVIDED IF APPLICABLE
PRINTED CD EMAIL INSPECTION OTHER___________________________________
HOW WOULD YOU LIKE TO RECEIVE RECORDS PICK UP MAILED EMAIL
INSPECTION OTHER ____________________________________________________________
DE
SCRIPTION
OF RECORD(S) REQUESTED:
_____________________________________________________________________________________
_________
____________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
IDENTIFIERS:
CASE NUMBER / PROJECT FILE NUMBER: ____________________________________________
DATE OF OCCURANCE:____________________________________________________________
LOCATION OF OCCURANCE:________________________________________________________
INCLUSIVE DATES OF RECORDS SEEKING:__________________________________________
DEPARTMENT FROM WHICH YOU ARE SEEKING RECORDS:___________________________
NAME OF INDIVIDUALS NAMED IN THE RECORD:____________________________________
SEARCH TERMS:___________________________________________________________________
OTHER____________________________________________________________________________
____________________________________
SIGNATURE OF REQUESTER DATE
FOR OFFICIAL USE
R
EQUEST
RECEIVED ___/___/______ TIME ___:_____ DEPARTMENT________________________
HOW REQUEST WAS RECEIVED MAIL EMAIL IN PERSON OTHER_________________
APPROVED WITHDRAWN NO RECORDS EXIST EXCEPT FROM DISCLOSURE
PROCESSOR______________________ AMOUNT CHARGED FOR RECORD________________
I
HAVE MET WITH A REPRESENTATIVE OF THE ABOVE OFFICE AND HAVE BEEN FULLY
PROVIDED ALL THE DOCUMENTS PURSUANT TO MY REQUEST
_________
_____________________________
SIGNATURE
OF REQUESTER
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STEVENS COUNTY PUBLIC RECORDS REQUEST FORM (Stevens County)

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Completed 18 July 2020

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