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KLICKITAT COUNTY REQUEST FOR PUBLIC RECORDS Klickitat County Ordinance No. 070516-2 Chapter 23.01 KCC (Klickitat County Code) TO BE COMPLETED BY REQUESTOR: DATE OF REQUEST: TIME: NAME: PHONE NUMBER ADDRESS: STREET CITY STATE ZIP EMAIL/OTHER CONTACT INFORMATION: I WOULD LIKE TO (mark all that apply): Inspect the public records Obtain copies of the public records DESCRIBE THE RECORDS YOU ARE REQUESTING: NOTE: If the request is for a list of names and/or addresses, please attach a signed statement, under the penalty of perjury, the purpose of the request and that the list will not be used for any commercial purposes. TO BE COMPLETED BY RECORDS OFFICER: DATE RECEIVED: TIME: OFFICE/DEPARTMENT/COMMISSION/BOARD: RECORDS OFFICER: was forwarded to Prosecuting Attorney’s Office for advice; was not forwarded to Prosecuting Attorney’s Office for advice. are available for inspection or copying (attach copy of letter to requestor required by KCC 23.01.090(c)(1)); are not identifiable and a request for clarification was made on this date by email or letter (attach copy of email or letter to requestor as required by KCC 23.01.090(c)(5); may be available, but more time is needed to respond (attach copy of letter to requestor required by KCC 23.01.090(c)(4)); are not available because they are exempt (attach copy of letter to requestor required by KCC23.01.090(c)(6); partially available for inspection or copying as some portion of the records are exempt and have been withheld and/or redacted (attach copy of letter to requestor required by KCC 23.01.090(c)(6)); are not available because no responsive records exist. Signature of Records Officer Date copies were inspected or provided to requestor; no response was received to request for clarification and requestor was notified request has been closed (attach copy of closure letter to requestor required by KCC 23.01.090(j)); records were exempt in their entirety and requestor was notified of exemptions no payment was received from requestor and requestor was notified that the request has been closed (attach copy of closure letter to requestor KCC 23.01.090((j)). Signature of Records Officer (or Prosecuting Attorney if request handled by PA’s office) Date Records: Request: Request closed because: