Form Center

2. Public Records Officer
   31627 1st Avenue S
   Federal Way, WA 98003
   Fax:253-839-9310
3. Instructions
   Request for Public Records Process - September 2017 (PDF)
5. Request for Public Records
7. Date/Time
   Date/Time

   Date/Time
9. Name of Requestor
11. Address
13. City
14. State
15. Zip Code
17. Phone Number
18. Email Address
    Please provide your email address if you would like us to respond via email.
    
    (If you would like a copy of this form emailed to you, you must enter your email address again in the submission section of this form.)
20. Description of Records Being Requested
    (Please be specific, using as many details as possible, i.e. dates, names, addresses, etc., so the District can clearly identify which records are being requested)
22. Additional Pages
    If more space is needed, please attach additional pages
24. Viewing Options

    Note: Payment is required prior to release of documents.

    1. Mail copies
    2. Hold copies for pickup
    3. Please do not make copies, but allow review of documents prior to copying
    4. If available, email copies, scan copies or provide compact disk for electronic data
26. I understand that Washington State law limits certain uses, including but not limited to RCW 42.17.130, prohibiting using lists of persons to promote election of persons or for promotion or opposition of ballot measures and RCW 42.56.070, prohibiting using lists of individuals for commercial purposes.
28. Signature of Requestor*

    By checking the box below you agree that the information on this form is correct.

    1. I Agree
30. Dated
    Dated
31. At
    Location
35. Fee Schedule for Public Records Request, RCW 42.56.120(2)(b)
    Printed copies - 15 cents per standard copy
    Scanned copies - 10 cents per page for records scanned into an electronic format
    Electronic files and/or electronic attachments - $0.05 per each 4 electronic files or attachment uploaded to email, etc.
    Transmission of records via electronic format - $0.10 per GB for transmission of records in electronic format
    Digital Media Storage – At cost
    Mailing costs – At cost
    Charges are subject to change or as otherwise provided by District Fees & Charges Resolution.
37. Print Option
    For best printing results, check the box to "Receive email copy" and provide your email address.
    
    Look for an email with subject line of: "Online Form Submittal: Lakehaven Request for Public Records Form". Ensure that your email program does not block email from "noreply@CivicPlus.com".
    
    Print the email from your email program.
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field