Public Request Form

Requester Information

Name (required)

Email (required)

Phone (Please provide a phone number in case we have any questions regarding your request.)

Category of Requester (required)

Records Request

Dates of Record: What is the range of dates for the request?

From (mm/dd/yyyy) (required)

To (mm/dd/yyyy) (required)

Description (required)

Name(s) on Record: Name of person(s) on the record or document and/or name of the person(s) involved in the category of records requested

Delivery Method: Unless otherwise specified, records will be emailed in an electronic format. You must specify if you wish to receive records in an alternative format (paper copies, CD, DVD, etc.) or via mail or in person. (required)

Commercial Request: If you are submitting a request for a commercial purpose, you must disclose this pursuant to A.R.S. 39-121.03. Please note that a commercial usage fee may apply. Commercial requests should include a fee schedule outlining the "value of the reproduction [of the record] on the commercial market" (A.R.S. 39-121.03(A)).

Yes

Attachment: Please attach any additional information that would help us process your request.

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