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2. GRAMA Request Form
4. Note:
   Utah Code § 63G-2-204 (GRAMA) requires a person making a records request furnish the governmental entity with a written request containing the requester’s name, mailing address, daytime telephone number (if available); and a description of the record requested that identifies the record with reasonable specificity.
6. Requester's Information
8. Today's Date:*
   Today's Date:
10. First Name*
11. Last Name*
13. Address1*
15. City
16. State*
17. Zip*
19. Daytime Telephone Number:
21. Request Made To:
23. Government Agency or Office:*
25. Agency Address:*
27. Agency City:*
28. Agency State:*
29. Zip Code*
31. Note:
    The more specific and narrow the request, the easier it will be for an agency or office to respond to the request. If you are unsure about the records’ description, contact the agency or office records officer
33. Note:
    Government keeps records in “series” or groups of records. To find out what series an agency or office maintains, visit the Archives’ website, http://archives.utah.gov. The record series retention schedules on the Archives’ website include relevant descriptions.
35. Title or series number of records (if known):
37. Description of Records:
    Description of records including all relevant information—location of event(s) described in records, city, county, address; date range of the records; names of the person(s); and subject of the request.
39. Restricted Access: Choose one
    -- Select One --I am the subject of the record.I am the authorized representative of the subject of the record. I provided the information in the record.

    Note: If the record has a restricted access, GRAMA provides that certain individuals may still receive access.
41. Considerations about the desired response.
43. I would like to: Choose all that apply from 1-4
45. 1.

    1. View or inspect the records only.
47. 2.

    1. Receive a copy of the records and pay associated fees. Please notify me if the amount will exceed
48. $
50. 3. Receive a copy of the records and request a fee waiver, according to Utah Code § 63G-2-203, because:
    -- Select One --Releasing the record primarily benefits the public.I am the subject, or authorized representative, of the record.My legal rights are directly implicated by the information of the record because ____________(answer below) , and I am impecunious.
52. If Legal Rights Implicated, give reason here:
54. 4.

    1. Receive an expedited response (5 days) because releasing the record benefits the public; I request the information for a story or report for publication or broadcast to the general public.
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit Submit and Print

* indicates a required field