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Request To Inspect UTCR 2.100 Segregated Information Sheet Form. This is a Oregon form and can be use in Uniform Trial Court Statewide.
Tags: Request To Inspect UTCR 2.100 Segregated Information Sheet, 2.100.8, Oregon Statewide, Uniform Trial Court
IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR COUNTY Division (court’s address and phone number) Case name: Plaintiff Name v. st 1 Defendant Name ) ) ) ) ) CASE No. REQUEST TO INSPECT UTCR 2.100 SEGREGATED INFORMATION SHEET By this form, I request to see or obtain a copy of part or all of a UTCR 2.100 Segregated Information Sheet (SIS) that is being withheld from the public. I have completed this form to provide the information the court requires of me to make this request. I understand the court will not automatically grant this request but will use applicable law to decide whether I have a right to see or copy the information I request. I understand this request will be a public record whether or not granted. 1. Information about me: a. b. c. d. e. 2. My Name: My Address: My Telephone number: Other contact information for me: I believe I have a legal right to see the information because (explain reasons): To identify the UTCR 2.100 Segregated Information Sheet (SIS) I am requesting: a. b. c. d. Name of person who submitted request for SIS: Date request submitted: Description of document from which information is segregated: General description(s) of protected personal information I am requesting to see (use same general description as on request in file): e. Row number(s) of description of this information on request: f. Name of person to whom information relates (if known): g. The request for the SIS shows that the SIS includes other information I am not requesting to inspect or copy (check one) Yes OR No. (If Yes, this other information will be redacted) Page 1 - Form 2.100.8 – REQUEST TO INSPECT UTCR 2.100 SEGREGATED INFORMATION SHEET – UTCR 2.100(8) (Revised 8-1-10) UTCR App. Page 5 American LegalNet, Inc. www.FormsWorkFlow.com 3. Confirming additional requirements completed: a. (Initial to confirm, “na” if not applicable) If this document was prepared by someone who is not an attorney, I have attached a completed document preparation certification that applies to both this request and the attached form as required by UTCR 2.010(7). b. (Initial to confirm) I have mailed or delivered copies of this request to the following persons required by UTCR 2.080 (list names): . c. (Initial to confirm) I understand that I will be responsible for any costs resulting from the court responding to this request except those costs for which I have obtained a waiver, and will advance money to cover those costs if requested by the court. I hereby declare that the above statement is true to the best of my knowledge and belief, and that I understand it is made for use as evidence in court and is subject to penalty for perjury. Signature Type or print name Date OSB# (if applicable) For Office use: Request to inspect Related comments: granted OR denied (state reason) Date: TRIAL COURT ADMINISTRATOR By Page 2 - Form 2.100.8 – REQUEST TO INSPECT UTCR 2.100 SEGREGATED INFORMATION SHEET – UTCR 2.100(8) (Revised 8-1-10) UTCR App. Page 6 American LegalNet, Inc. www.FormsWorkFlow.com