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2. First Name*
3. Last Name*
5. Mailing Address 1*
7. Mailing Address 2
9. City*
10. State*
11. Zip*
13. Phone Number*
14. Email Address*
16. Is this a commercial request?*

    1. Yes

    1. No
18. How do you want to receive the requested records?*

    1. Paper Copy
    2. Electronic Copy

    1. Inspect Records
20. Identifiable Records Requested*
    Please describe the public records you wish to receive. In order to expedite the search for the records, please be as specific as possible. Include case number, permit number, timeframe, etc.
22. Department*

    1. Police
    2. Building
    3. Public Works

    1. Administration
    2. Clerk/Finance
    3. Other
24. Signature of person making the request
    The City will respond to this request within five (5) working days.
26. Do you agree?*

    By checking "I Agree", I agree and acknowledge that 1) my application will not be "signed" in the sense of a traditional paper document, 2) By signing in this alternate manner, I agree that my "electronic signature" is valid and binding upon me to the same force and effect as a handwritten signature, 3) I agree any lists of individuals obtained through this Request will not be used for commercial purposes RCW 42.56.070(9), and 4) I have read and understand the City of Quincy Public Records Policies and Procedures.

    1. I Agree
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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit Submit and Print

* indicates a required field