Records Request - Government Records & Management Act (GRAMA)

Date

First Name *

Middle Name

Last Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

eMail Address *

Description of Record(s) sought * must be described with reasonable specificity *

I would like to inspect the records

I would like to receive copies of the records

I understand I am responsible for copies or other costs up to (enter maximum cost below) and that the agency will contact me if costs exceed this amount; the agency will not fill the request if I have not authorized adequate costs.

Maximum cost in dollars you for which you accept responsibility *

I request a waiver of copy costs. (Please provide justification for this request below; verification may be required. Refer to UCA 63-2-203(4) for a list of situations under which an agency is encouraged to provide copies without charge.)

Verify your reason for requesting a fee waiver per UCA 63-2-203

I request an expedited response. (Please fill in the following 2 text boxes to verify you are entitled to an expedited response. Refer to UCA 63-2-204(4)

Please provide verifiable information to confirm your status as a current member of the media (verification may be required before request is fulfilled.)

Please reason for request for expedited records as part of a story, broadcast or publication. See UCA 63-2-204.

Reason for Request: Please check one of the following.

The record is a public record available for my review

I am the subject of the record

I am the person who provided the information

I am authorized by the subject of the record or by the person who submitted the information (a copy of authorization will be required prior to fulfillment of this Record Request).

Digital Signature

* - denotes required field