| (a) | . . . . . . . . . . . . . . .
Name
(Please Print) | | . . . . . . . . . . . . . . .
Signature |
| . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of Organization, if Applicable |
| | . . . . . . . . . . . . . . .
Mailing Address
of Applicant | | . . . . . . . . . . . . . . . . .
Telephone
number |
| (b) | . . . . . . . . . . . . . . .
Date Request
Made | | . . . . . . . . . . . . . . . . .
Time of Day
Request Made |
| (c) | Nature of Request . . . . . . . . . . . . |
| . . . . . . . . . . . . |
| . . . . . . . . . . . . |
| (d) | Identification Reference on Current Index . . . . . . . . . . . . |
| . . . . . . . . . . . . |
| . . . . . . . . . . . . |
| (e) | Description of record or matter requested if not identifiable by reference to any Washington state military department current index . . . . . . . . . . . . |
| . . . . . . . . . . . . |
| . . . . . . . . . . . . |
| . . . . . . . . . . . . |
| Request: |
Approved . . . . . . . .
Date | | By . . . . . . . . . . . .
Public Records
Officer |
Denied: . . . . . . . . . . . .
Date | | |
| Reasons for Denial: . . . . . . . . . . . . |
| . . . . . . . . . . . . |
| . . . . . . . . . . . . |
| Referred to . . . . . . . . . . . | | By . . . . . . . . . . . .
Public Records
Officer |