GRAMA Request Form

REQUEST FOR RECORDS

First Name

Last name

Representing

Address

City

State

Zip

Daytime Number

Email Address

RECORD INFORMATION

PURPOSE FOR REQUEST

If the Requested Records are not Public, explain why you believe you are entitled to access:

I am the Subject of the Record.

I am the Person who provided the Information.

I represent a Government entity requesting access under UCA 63G-2-206 Sharing Records. ( see attachment for ADDENDUM A ) .

I am authorized to have access by the subject of the record or by the person who submitted the information.(You will be contacted for a copy of the authorization pursuant to UCA 63G-2-202)

Other (Explain)

GENERAL FEES

Documents copies per paper record : $10 minimum, up to 10 pages and $0.50 for each additional page, plus mailing costs(if applicable).

Audio copies per incident : $20 minimum, upto 1/2 hours of research and $10 for each additional 1/2 hour of research, plus mailing costs(if applicable).

Indicate your preferred method of payment :

Electronic Payment

Mail a Business check or Money order

Deliver Cash or Business Check during normal Business hours

I want to Review the record only during normal Business hours

I am requesting a Fee Waiver because

I am a member of the media and release of the record will benefit the public rather than a person, OR

I am an impecunious and my legal rights are directly implicated by the information in the record.

Indicate your preference for receiving the Record :

Electronic

U.S. Mail

Pick up in person during normal Business hours

ACKNOWLEDGEMENT
I affirm the Information provided by me is true and accurate to the best of my knowledge. I understand that I will be responsible for the costs associated with providing the record(s) as permitted under UCA 63G-2-203.

I am requesting an expedited response (within 5 business days) because I believe my request benefits the public rather than the person, as described below:(you must provide an explanation in the additional )

REQUEST FOR RECORDS

If the Requested Records are not Public, explain why you believe you are entitled to access:

I am the Subject of the Record.

I am the Person who provided the Information.

I represent a Government entity requesting access under UCA 63G-2-206 Sharing Records. ( see attachment for ADDENDUM A ) .

I am authorized to have access by the subject of the record or by the person who submitted the information.(You will be contacted for a copy of the authorization pursuant to UCA 63G-2-202)

Other (Explain)

GENERAL FEES

Documents copies per paper record : $10 minimum, up to 10 pages and $0.50 for each additional page, plus mailing costs(if applicable).

Audio copies per incident : $20 minimum, upto 1/2 hours of research and $10 for each additional 1/2 hour of research, plus mailing costs(if applicable).

Indicate your preferred method of payment :

Electronic Payment

Mail a Business check or Money order

Deliver Cash or Business Check during normal Business hours

I want to Review the record only during normal Business hours

I am requesting a Fee Waiver because

I am a member of the media and release of the record will benefit the public rather than a person, OR

I am an impecunious and my legal rights are directly implicated by the information in the record.

Indicate your preference for receiving the Record :

Electronic

U.S. Mail

Pick up in person during normal Business hours

ACKNOWLEDGEMENT
I affirm the Information provided by me is true and accurate to the best of my knowledge. I understand that I will be responsible for the costs associated with providing the record(s) as permitted under UCA 63G-2-203.

I am requesting an expedited response (within 5 business days) because I believe my request benefits the public rather than the person, as described below:(you must provide an explanation in the additional )

REQUEST FOR RECORDS

If the Requested Records are not Public, explain why you believe you are entitled to access:

I am the Subject of the Record.

I am the Person who provided the Information.

I represent a Government entity requesting access under UCA 63G-2-206 Sharing Records. ( see attachment for ADDENDUM A ) .

I am authorized to have access by the subject of the record or by the person who submitted the information.(You will be contacted for a copy of the authorization pursuant to UCA 63G-2-202)

Other (Explain)

GENERAL FEES

Documents copies per paper record : $10 minimum, up to 10 pages and $0.50 for each additional page, plus mailing costs(if applicable).

Audio copies per incident : $20 minimum, upto 1/2 hours of research and $10 for each additional 1/2 hour of research, plus mailing costs(if applicable).

Indicate your preferred method of payment :

Electronic Payment

Mail a Business check or Money order

Deliver Cash or Business Check during normal Business hours

I want to Review the record only during normal Business hours

I am requesting a Fee Waiver because

I am a member of the media and release of the record will benefit the public rather than a person, OR

I am an impecunious and my legal rights are directly implicated by the information in the record.

Indicate your preference for receiving the Record :

Electronic

U.S. Mail

Pick up in person during normal Business hours

ACKNOWLEDGEMENT I affirm the Information provided by me is true and accurate to the best of my knowledge. I understand that I will be responsible for the costs associated with providing the record(s) as permitted under UCA 63G-2-203.

I am requesting an expedited response (within 5 business days) because I believe my request benefits the public rather than the person, as described below:(you must provide an explanation in the additional )

ACKNOWLEDGEMENT
I affirm the Information provided by me is true and accurate to the best of my knowledge. I understand that I will be responsible for the costs associated with providing the record(s) as permitted under UCA 63G-2-203.