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2. Requestor's Name*
4. Address*
6. City*
7. State*
8. Zip*
10. Daytime Telephone*
11. Email Address*
13. Description
    In accordance with the Governmental Records Access Management Act, I am seeking the following record(s) SPECIFICALLY described:
14. Detailed Description*
16. I would like to

    1. view/inspect the record
    2. receive copies of the requested(s). I understand that I will be responsible for copy cost.
    3. I would like to receive a copy of the records and request a waiver of copy costs because:
18. 1. Release of the records primarily benefits the public rather than me.
    2. I am the subject of the record.
    3. I am the authorized representative of the subject of the record.
    4. My legal rights are directly affected by the record and I am impecunious.
20. If the requested records are not public, please explain why you believe you are entitled to access.

    1. I am the subject of the record.
    2. I am the person who provided the information
    3. I am authorized to have access by the subject of the record or by the person who submitted the information. (Please attach documentation required by UCA 63-2-202.)
    4. Other - Explain
22. Explanation
24. Expedited Response

    I am requesting expedited response. (Please attach information that shows your status as member of the media and a statement that records are required for a story for broadcast or publication; or please attach other information that demonstrates that you are entitled to expedited response under UCA 63-2-202(3))

    1. yes
    2. no
26. Signature*
27. Date*
29. ** The request may be delayed if all information requested is not provided.
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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit Submit and Print

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