Request For Release Of Public Records Form - City Of Chehalis Public Record Access printable pdf download

CITY OF CHEHALIS PUBLIC RECORDS ACCESS

Request for Release of Public Records

NAME OF REQUESTER: _____________________________________

DATE: __________________________________

CONTACT INFORMATION:

Address:

______________________________________________

Phone:

______________________________________________

Email Address: ______________________________________________

How would you like to be contacted, please check one: Mail _____ Phone _____ Email _____

I request copies of the following public records:

____________________________________________________________________________________________________

I understand that Washington State law, RCW 42.56.070 (9), prohibits the use of lists of individuals for commercial purposes.

I understand that the use for commercial purposes of said records may also violate the rights of the individuals named therein and may subject me

to liability for such commercial use.

I understand that Sections 2 and 3 herein apply when I use said records for commercial purposes and when others use said records or copies of

same for commercial purposes. I understand that I may be liable in either case.

I understand that "commercial purposes" means that the person requesting the record intends that the list will be used to communicate with the

individuals named in the record for the purpose of facilitating profitexpecting activity.

Therefore, I will not use said records for commercial purposes and that it is my affirmative duty to prevent others from using said records for

commercial purposes.

Further, I will protect and hold harmless, including the cost of defending the agency and its agents and employees from whom I have obtained said

records, from any and all claims arising either directly or indirectly from the commercial use of said records.

________________________________________

Signature

FOR CITY USE ONLY

Date Request Received by City: ______________________________

Amount $____________________

Date Request Responded to by City: __________________________

Date Request Closed: _________________

□

Records Request Provided _______________________________

Records Request Denied ________________________

City Attorney

Revised May 9, 2011

Request For Release Of Public Records Form - City Of Chehalis Public Record Access