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2. Pursuant to RCW 42.56, Washington State Public Disclosure Act, I hereby request to review a record maintained by the Anacortes Police Department and do assert my identity to be:
4. Last Name or Name of Business:
6. First Name:
7. Date of Birth:
9. Mailing Address:
11. City:
12. State:
13. Zip Code:
15. Phone Number:
16. Email:
18. How would you like to receive your records?

    1. Mail
    2. Email
20. Signature of Requestor:
21. Date:
23. Requested

    1. Copy
    2. Inspection
24. Purpose:
26. Incident/Case #:
28. My involvement in Incident/Case:
30. Type/Nature of Incident:
32. Date/Time of Incident:
34. Location of Incident:
36. Additional Information if the incident/case number is unknown:
    Include other information; other names in the report; briefly describe the information to be disclosed by the Anacortes Police Department.
38. Costs:
    There is no charge to "inspect" public records but inspections are by appointment only. Pursuant to RCW 42.56.520, within five business days of receiving a public record request, an agency must respond by either (1) providing the record; (2) acknowledging that the agency has received the request and providing a reasonable estimate of the time the agency will require to respond to the request; or (3) denying the public record request. Denials of requests must be accompanied by a written statement of the specific reasons or or exemptions.
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40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field