GRAMA Request Form

First Name*

Last Name*

Organization (if applicable)

Full Address*

Street

City

State

Zip

Phone #*

Email Address*

City department or agency that maintains requested records (if known)

Description of requested records*

(records must be described with reasonable specificity)

How would you like to receive the requested records?

Inspect Only

Paper Copy

Electronic Copy

I understand there may be fees associated with my request. Fees are charged in accordance with Utah Code 63G-2-203*

I am requesting a waiver of costs for the following reason(s):

Pursuant to Utah Code Ann. 63G-2-203 (4)

I do hereby certify that the following apply to me

I am the subject of the record

Person Who Provided

I am the person who provided the information

I Am Authorized

I am authorized to have access by the subject of the record by the person who submitted the information and documentation required by Utah Code

Agency

A state, local, or federal agency

Member of Press

A member of the press or broadcast media

Other

If other, please explain

Response Request

I am requesting expedited response as permitted by Utah Code Ann. 63G-2-204(4). (Please attach information that shows your status as a member of the media and a statement that the records are required for a story for broadcast or publication; or other information that demonstrates that you are entitled to expedited response.)

Please upload a copy of your government issued identification and any applicable credentials (journalist, etc.)*

.pdf or images only, 15MB limit

Captcha Response*

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