UTAH GOVERNMENT RECORDS REQUEST FORM
TO: __________________________________________________________________________________
(Name of government office holding the records and/or name of agency contact person.)
Address of government office: ________________________________________________________
_________________________________________________________________________________
Description of records sought (records must be described with reasonable specificity):
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
I would like to inspect (view) the records.
I would like to receive a copy of the records. I understand that I may be responsible for fees associated with
copying charges or research charges as permitted by UCA 63G-2-203. I authorize costs of up to $ .
UCA 63G-2-203 (4) encourages agencies to fulfill a records request without charge. Based on UCA 63G-2-203 (4),
I am requesting a waiver of copy costs because:
releasing the record primarily benefits the public rather than a person. Please explain:
___________________________________________________________________________________
___________________________________________________________________________________
I am the subject of the record.
I am the authorized representative of the subject of the record.
My legal rights are directly affected by the record and I am impoverished.
(Please attach information supporting your request for a waiver of the fees.)
If the requested records are not public, please explain why you believe you are entitled to access.
I am the subject of the record.
I am the person who provided the information.
I am authorized to have access by the subject of the record or by the person who submitted the information.
Documentation required by UCA 63G-2-202, is attached.
Other. Please explain:
__________________________________________________________________________________
__________________________________________________________________________________
I am requesting expedited response as permitted by UCA 63G-2-204 (3)(b). (Please attach information that shows
your status as a member of the media and a statement that the records are required for a story for broadcast or
publication; or other information that demonstrates that you are entitled to expedited response.)
Requester’s Name:________________________________________________________________
Mailing Address:__________________________________________________________________
Daytime telephone number: Date:______________________
Signature:________________________________________________________________________
