Requestor Name:

Address:

City:

State:

Zip:

Phone:

Email:

I request the Attorney General to order the state agency named below to provide me with the following records (describe records):

Name of Agency:Accountancy, State Board OfAdministrative Hearings, Office OfAdministrative Services, Department ofAgriculture, Department OfAppraiser Certification And Licensure BoardArchitect Examiners, Oregon State Board ofAviation, Oregon Department OfBlind, Commission For TheBoundary CommissionsChief Education OfficeChiropractic Examiners, Board OfColumbia River Gorge CommissionCommunity Colleges And Workforce Development, Dept. OfConstruction Contractors BoardConsumer & Business Services, Department OfCorrections, Department OfCourt Procedures, Council OnCriminal Justice Commission, OregonDentistry, Board OfDepartment of RevenueDriver And Motor Vehicle, Division ofEarly Learning DivisionEducation, Oregon Department OfEmployment DepartmentEmployment Relations BoardEnergy, Department OfEngineering And Land Surveying, Board of Examiners ForEnvironmental Quality, Department OfEthics Commission, Oregon GovernmentExecutive OfficeExposition Center and State Fair, OregonFilm & Video, OregonFish And Wildlife, Department OfForest Resources Institute, OregonForestry, OR Department ofGeologist Examiners, Board OfGeology & Mineral Industries, Department OfGOVERNOR'S OFFICEHealth Authority, OregonHealth Policy & Analytics DivisionHealth Related Licensing BoardsHECC Office of Student Access and Completion (OSAC)Higher Education Coordinating Commission (HECC)Housing and Community Services, OregonHuman Services, Dept. ofJudicial DepartmentJudicial Fitness And Disability, Commission OnJustice, Department ofLabor And Industries, Bureau OfLand Conservation And Development DepartmentLand Use Board of AppealsLands, Department of StateLandscape Architect BoardLandscape Contractors BoardLegislative AdministrationLegislative AssemblyLegislative Commission On Indian ServicesLegislative Counsel, Office of theLegislative Fiscal OfficeLegislative Revenue OfficeLicensed Social Workers, Board ofLicensed Social Workers, Board ofLiquor Control Commission, OregonLong-Term Care Ombudsman, Office of theLottery, Oregon StateManagement Resources DivisionMarine Board, Oregon StateMassage Therapists, Board OfMedical Board, OregonMedical Imaging, Board OfMental Health Regulatory AgencyMilitary Department, State of OregonNaturopathic Examiners, Board OfNorthwest Power & Conservation CouncilNursing, Board OfOccupational Therapy Licensing BoardOptometry, Board OfOregon Advocacy Commissions OfficeOregon Board of Licensed Professional Counselors and TherapistsOregon Board of Parole and Post-Prison SupervisionOregon Board of PsychologyOregon Business Development DepartmentOregon Corrections EnterprisesOregon District Attorneys AssociationOregon Health Licensing AgencyOregon Mortuary and Cemetery BoardOregon Public UniversitiesOregon Tourism Commission/Travel OregonOregon Wine BoardPacific States Marine Fisheries CommissionParks and Recreation DepartmentPharmacy, Oregon Board OfPhysical Therapist Licensing BoardPolice, Oregon State Department OfPsychiatric Security Review BoardPublic Defense Services, Office OfPublic Employees Retirement SystemPublic Employees' Benefit BoardPublic Safety Standards And Training, Department OfPublic Utility CommissionRacing CommissionReal Estate AgencyRecreational Marijuana DivisionSecretary of StateSpeech Pathology & Audiology, Board Of Examiners ForState Library of OregonStudent Access Commission, OregonTax Practitioners, Board OfTeacher Standards And Practices CommissionTransportation, Department OfTravel Information CouncilTreasury, Oregon StateVeterans' Affairs, Department OfVeterinary Medical Examining BoardWater Resources DepartmentWatershed Enhancement BoardYouth Authority, OregonYouth Development DivisionOther

Other (Agency):

Date of Records Request:

Name of Official Who Denied Request:

Date of Denial:

Petitioners are encouraged to attach copies of any supporting documentation, such as a copy of their written records request to the agency and any other agency correspondence, with their petition. File Upload (Type: DOC, DOCX, PDF, TXT, JPG, GIF; Limit: 2MB each):