Office of the Government Records Ombudsman
Utah State Archives and Records Service
http://archives.utah.gov/opengovernment/ombudsman.html
GRAMA Request Form
used to request records from any governmental entity
Note: Utah Code § 63G-2-204(1) (GRAMA) requires a person making a records request to furnish the governmental entity with a written request containing the requester's name, mailing address, daytime telephone number, and email address if the person is willing to receive communications by email. The request must also include a description of the being record requested that identifies the record with reasonable specificity. The request must be made to the governmental entity that created or maintains the records.
Requester information:
Date:
*
-
Month
-
Day
Year
Date
Name:
*
First Name
Last Name
Mailing Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Daytime phone number:
*
Format: (000) 000-0000.
Email address:
*
example@example.com
Request made to:
Government agency or office:
*
Records officer's name (if known):
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone number:
Format: (000) 000-0000.
Email address:
example@example.com
Records requested:
Note: The more specific the request, the easier it will be for records officers to respond.
Title or subject of records:
*
Description of records including all relevant information -- date range of records, name of involved person(s), location of event(s), and other descriptive information:
*
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Office of the Government Records Ombudsman
Utah State Archives and Records Service
http://archives.utah.gov/opengovernment/ombudsman.html
Details for records that may have restricted access:
Note: Some records may be classified as private, controlled, or protected, or access may be limited by another statute. Access to restricted records is provided for in the relevant other statutes or in Utah Code § 63G-2-202(1)(2)(4).
Are you the subject of the record?
Yes
No
Are you an authorized representative of the subject of the record (parent, guardian, someone with power of attorney or notarized release:
Yes
No
If yes, explain and attach documentation:
Did you provide the record to the governmental entity?
Yes
No
Describe your connection to an incident or event that is the subject of the record:
Details for records the release of which may be in the public interest:
Note: Release of some records is in the public interest. Such records may be eligible for a fee waiver and/or expedited response as provided in Utah Code § 63G-2-203(4) and Utah Code § 63G-2-204(4)(5).
Are you requesting an expedited response?
Yes
No
Will the record be used for a news story or publication?
Yes
No
If yes, which channel or publication?
Explain other justification that release of the record will benefit the public.
Details for records that may be eligible for a fee waiver:
Note: Government entities are encouraged to waive fees in certain circumstances as outlined in Utah Code § 63G-2-203(4).
Do you want this request to be considered for a fee waiver?
Yes
No
Does release of these records benefit the public?
Yes
No
Are you the subject of the record?
Yes
No
Are you an impecunious (without money) individual whose legal rights are affected by access to the requested records?
Yes
No
Additional access considerations:
Note: Additional details about obtaining access to records are outlined in Utah Code § 63G-2-201, 203, and 204.
Would you like the records to be provided in a particular format?
Yes
No
If yes, explain
Do you want to be contacted if the cost of providing records exceeds a certain amount?
Yes
No
If yes, state the amount
Rather than receiving copies of the requested records, would you like to view them in the office of the governmental entity?
Yes
No
If yes, arrangements must be made with the entity's record officer.
Explain anything else you would like to be taken into consideration regarding this request:
Note: Governmental entities are required to respond within 10 business days as outlined in Utah Code § 63G-2-204(4)(b) or 5 days for expedited response.
GRAMA Request Form
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