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Declaration Under Penalty of Perjury

Please correct the field(s) marked in red below:

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Email Address
 *
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7.  I or my organization/business attest that another law authorizes or directs the agency to provide me or my organization/business the list of individuals requested.
7. I or my organization/business attest that another law authorizes or directs the agency to provide me or my organization/business the list of individuals requested.

I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.  I certify under penalty of perjury that I have read the first page of this declaration form and I understand that a list of individuals cannot be provided to me or to my organization or business by the City if the list will be used for commercial purpose.  I certify under penalty of perjury that any list of individuals I or my organization or business received will not be used for any commercial purpose in violation of RCW 42.56.070(9).

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a.  If an organization or business, the name of the organization or business is:
 *
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b.  If an organization or business, the purpose of the organization or business is:
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Name of Requestor
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d.  If an organization or business, (i) it is a professional association or educational organization recognized by the professional licensing or examination board, and (ii) the request is for a list of applicants for:

The Washington State Public Records Act (“Act”) (RCW 42.56.070(9) does not allow the City to provide access to list of individuals requested for commercial purposes. As allowed by the Act, the City to requires a requester to provide information as to the purpose of a request “to establish whether inspection and copying would violate RCW 42.56.070(9). Likewise, the Washington State Court of Appeals requires the City to investigate if a request might be used for commercial purposes, in order to comply with the obligations of RCW 42.56.070(9). SEIU Healthcare 775 NW v. State, 193 Wn. App. 377, 377 P. 3d 214 (2016).

To ensure that records that you requested will not be used for a commercial purpose, please complete the following declaration.

If the City does not receive a completed declaration, we will be unable to process your request for the list and the request for the list will be administratively closed. If we have questions for you after you complete the declaration, we will contact you.

The declaration is a public record.


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6.  I or the organization/business intend to supply or sell the list of individuals to any organization or business, third party individual (someone other that myself paragraph 2), or any other.
6. I or the organization/business intend to supply or sell the list of individuals to any organization or business, third party individual (someone other that myself paragraph 2), or any other.
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Declarer's Contact Information 
Declarer's Contact Information
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5.  I or the organization/ business intend to make individuals on the list aware of business commercial entities, business/financial enterprises or business/financial opportunities:
5. I or the organization/ business intend to make individuals on the list aware of business commercial entities, business/financial enterprises or business/financial opportunities:
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c.  If an organization or business the mailing address and website address are:
 *
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 I am requesting the records for:

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I am requesting the records for:
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Date
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4.  I or the organization/business intend to solicit money or financial support from any of the individuals on the list:
4. I or the organization/business intend to solicit money or financial support from any of the individuals on the list:
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3.  The purpose in making this request for the list of individuals is:
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Phone Number
 *
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Declarer's Title (if any):
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Signature of Declarant

Return this completed declaration form (both sides) to the Public Records Officer or other designated person at:  Dana Barnard, 271 9th Street N.E., East Wenatchee, WA 98802 or dbarnard@east-wenatchee.com.

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I am requesting the records for
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City  State
City State
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