Dixie State University :: Public SafetyRecord Sharing Agreement for Governmental Entities

NOTE: Utah Code Section 63G-2-206(1)(2)(3) states that a governmental entity may provide a record that is private, controlled, or protected to another governmental entity, a government-managed corporation, a political subdivision, the federal government, or another state. Further details are defined.

Originating Governmental Entity Information

Agency Name *

Address *

Address

City

State/Province

Zip/Postal

Country

Records Officer or Contact Person *

Telephone Number *

Email Address *

Recipient Governmental Entity Information

Agency Name *

Address *

Address

City

State/Province

Zip/Postal

Country

Records Officer or Contact Person *

Telephone Number *

Email Address *

Description of Records Being Shared

Title / Series Number / Description *

Inclusive Dates *

Format *

Reason for Sharing Records *

Records Classification Designation(s) *

Legal Citation Supporting Classification Designation(s) *

NOTE: Utah Code Section 63G-2-206(4) says that before disclosing a record or record series to another governmental entity, another state, the United States, a foreign government... the originating governmental entity shall:

inform the recipient of the record's classification and the accompanying restrictions on access; and
if the recipient is not a governmental entity to which the Government Records Access and Management Act applies, obtain the recipient's written agreement that it will abide by specified access restrictions unless a statute, federal regulation, or interstate agreement otherwise governs the sharing of the record or record series.

Also, Utah code section 63G-2-206(6) states that an entity receiving a record is subject to the same restrictions on disclosure of the record as the originating entity.

Recipient entity agrees to abide by the following access restrictions and instructions: *

If recipient entity receives a GRAMA request, originating entity requests that recipient entity

Provide access based on instructions herein provided

Refer the requester back to the originating entity for access

E-Signature of Chief Administrative Officer or Records Officer *

Date *

Contact

Other

Office Hours

Office Location

Record Sharing Agreement for Governmental Entities

Originating Governmental Entity Information

Recipient Governmental Entity Information

Description of Records Being Shared