| REQUEST FOR PUBLIC RECORDS |
| To: |
Public Records
Officer |
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DATE OF
REQUEST |
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TIME OF
REQUEST |
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Centralia College |
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| PUBLIC RECORDS OR INFORMATION
REQUESTED |
REQUESTED BY |
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NAME: |
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ORGANIZATION: |
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MAILING ADDRESS: |
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REQUESTER READ AND SIGN |
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| COMPLETED
BY PUBLIC
RECORDS
OFFICER |
ACKNOWLEDGMENT
OF RECEIPT |
I understand that I must
abide by the rules and
regulations published by
Centralia College for the
protection of public
records, a copy of which I
have read and understand. |
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| NO. OF
COPIES |
AMOUNT
RECEIVED |
DATE OF
RECEIPT |
TIME OF RECEIPT |
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| PUBLIC RECORDS OFFICER
SIGNATURE |
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RECIPIENT'S SIGNATURE |
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| REASON IF UNABLE TO
COMPLY: |
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I understand that I will be
charged per copy for all
standard letter size copies I
desire and that other size
publications are available
at cost. |
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REQUESTOR'S SIGNATURE |
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| Public records of Centralia College are provided for
inspection and copying subject to the following regulations: |
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| WAC 132L-276-120 Protection of public records. |
| (1) |
No person shall knowingly alter, deface, or destroy
public records of Centralia College. |
| (2) |
Care and safekeeping of public records of Centralia
College, furnished pursuant to a request for
inspection or copying, shall be the sole responsibility
of the requestor. |
| (3) |
Records furnished for public inspection or copying
shall be returned in good condition and in the same
file sequence or organization as when furnished. |
| (4) |
Boisterous or otherwise disruptive conduct by those
requesting public records of Centralia College shall
not be permitted. |
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| I have read, understand, and will comply with the
above-stated regulations. |
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Requestor's Signature and Date |
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