City of Milton

Office of the City Clerk, 1000 Laurel Street, Milton, WA98354 (253) 517-2705

PUBLIC RECORD REQUEST

For City Use Only:

Received by: ______PDR #: ______

Name of Requestor: ______Daytime Telephone: ______

Name of Company: ______

Address: ______

Street or P.O. Box No.

______

City State Zip Code

Describe specific records requested in detail:

______
______

______

(Please continue on back or add additional sheets if necessary.)

Please check the appropriate box:

□I would like to inspect the records.

□I would like copies of the records and will pick them up when they are available. NOTE: The City of Milton charges $.15 per page/B&W copy over 25 pages and $.25 per page for color copies (Res. 08-1756)

□I wouldlike copies of the records sent to me by mail to the address listed above. I understand if there are any reproduction and postage fees associated with the records I am requesting, the City must receive payment for the copies I have requested before sending them to me.

The receipt of your copy of this form constitutes the City’s initial response to your request for records. The City estimates that it will take approximately _____ days/weeks to respond to your request. If the preceding space is blank, the City estimates that it will take two weeks to respond to your request. The estimated time required to respond to your request may be based upon the need to locate and assemble the records, to notify third persons or agencies affected by the request, to determine whether any of the information is exempt from disclosure, to redact documents containing material that is exempt from disclosure, or to obtain clarification of the request.

Please note: State law requires that responses to requests for public records be made “promptly." Specifically, cities and other governmental agencies must respond, within five business days of receiving a request, by either: (1) Providing the record; (2) Acknowledging receipt of the record and providing a reasonable estimate of the time in which a response will be made; or (3) Denying the request. Duplication costs will be assessed at the actual cost or as outlined in the City’s current Fee resolution.

Lists for Commercial Purposes

WashingtonState law, RCW 42.56.070(9), prohibits the City from providing access to lists of individuals requested for commercial purposes. “Commercial purposes” means that the requestor requesting such information from the public records of the City intends to use the information to contact or in some way personally affect the individuals identified on the list and when the purpose of the contact would be to facilitate the requestor’s commercial activities.

I hereby declare, under penalty of perjury under the laws of the State of Washington, that the list of individuals I have requested from the City of Milton under this request for public records will not be used for commercial purposes.

Signed at ______, Washington, this_____ day of , ______.

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Signature of Requestor

Office Use Only:

Status: ______

Amount Due: ______Date Closed: ______By: ______

Number of Copies: