KITSAP COUNTY ASSESSOR Jim Avery
614 Division St. MS-22, Port Orchard WA 98366 Phone (360) 337-7160 Fax (360) 337-4874 Email: assessor@co.kitsap.wa.us
REQUEST FOR PUBLIC RECORDS
I, __________________________________, the undersigned, request the following documents:
I am aware of Section 26, Chapter 1, Washington Laws of 1973 (Int. #276 [RCW Title 42]) and release forever, discharge, and hold harmless from any and all claims, demands, or and causes of action of any nature whatsoever which may arise as a result of Kitsap County’s release of this information to me and any use to which I may put it. I further state that I am not requesting a list of individuals for commercial purposes, nor will I use these documents in any way which would violate the laws of the State of Washington, or which would violate the personal privacy of any individual, or which would impair in any way vital government interests. I understand that the county does not warrant that data supplied on recording media will be usable by any particular hardware or software configuration, and that it is my responsibility to determine the suitability and compatibility of this information and its format prior to purchase. I will not hold Kitsap County responsible for damage to recording media which I provide, or for data thereon, or for damage to hardware or software which may result from the use of said media after it has been processed by the County.
Name of organization, if applicable
Street address or post office box
Telephone number
City, State and ZIP
e-mail address (optional)
Signature
For County Use Only
Completed by: Delivery (Circle one): Amount paid: Pick-up Mail Invoice #: Date:
Date