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Records Request Form

2. Description of Records Sought
   Records must be described with reasonable specificity.
4. Request Type

   1. I would like to inspect (view) the records.
   2. I would like to receive a copy of the records. I understand I may be responsible for fees associated with copying charges or research charges as permitted by Utah Code (UCA) 63-2-203.
6. I authorize costs of up to:
8. UCA 63-2-203 (4) encourages agencies to fulfill a records request without charge. Based on UCA 63-2-203 (4), I am requesting a waiver of copy costs because:

   1. Releasing the record primarily benefits the public rather than a person. Please explain.
   2. I am the authorized representative of the subject of the record.
   3. My legal rights are directly affected by the record, and I am impoverished.
10. Why does the release of the record primarily benefit the public rather than a person?
12. Please include information supporting your request for a waiver of the fees.
14. Non Public

    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. Documentation required by UCA 63-2-202, is attached.
    4. Other.
16. Documentation required by UCA 63-2-202
18. Other. Please explain.
20. Expedited Response

    1. I am requesting expedited response as permitted by UCA 63-2-204 (3)(b).
21. Please attach information that shows your status as a member of the media and a statement that the records are required for a story for broadcast or publication; or other information that demonstrates that you are entitled to expedited response.
23. Requestor's Name
25. Email Address
27. Mailing Address
29. Daytime Phone Number
30. Date
    Date
32. Signature
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field