415-06-110 - Adoption of form

415-06-110. Adoption of form

The director hereby adopts for use by all persons requesting inspection and/or copying or copies of the department records, the form attached hereto as Appendix A, entitled "Request for public record."

APPENDIX A

REQUEST FOR PUBLIC RECORDS

Name of Requestor:

Address:

Phone:

Date of Request:

Time of Request:

Nature of Request:

1.

Index Reference . . . . . . . . . . . .

2.

If not identifiable by reference to the index, then

describe the document(s) in detail . . . . . . . . . . . .

  

. . . . . . . . . . . .

  

. . . . . . . . . . . .

  

. . . . . . . . . . . .

Signature

. . . . . . . . . . . .

For Office Use Only:

(1)

Request

Granted []

Record

Withheld []

Record Withheld

In part []

(2)

If withheld, name the exemption contained in section 31, chapter 1, Laws of 1973, which authorizes the withholding of the record or part of record: Subsection (1) ().

(3)

If withheld, briefly explain how the exemption applies to the record withheld.

(4)

If request granted, time. . . . . . ., day. . . . . . . . .

Order 4, § 415-06-110, filed 7/27/77.

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