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REQUEST FOR PUBLIC RECORDS
Name: ______________________________________ Date: ____________
Address: _______________________________________________________
(Street) (City) (State) (Zip)
Phone: Home: ____________________ Work: _______________
Nature of Request:
□ Opportunity to review records (no original record may leave
this office
□ Copies of records
Please read and sign the following statement:
I have requested public records for a noncommercial purpose. I understand that if the records should be used for a commercial purpose, a verified statement of the purpose must be submitted per A.R.S. §39-121.03.
_________________________ ________________________________
Date Signature
Notice: A fee of $0.25 will be charged per page.
Records Request (please be as explicit as possible as to the records you desire):
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
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