AgendaQuick™ – Public Records Request

Preferred Delivery Method:

Name:

Title:

Mr.

Ms.

* First Name:

Middle:

* Last Name:

Company:

Mailing Address:

Street Address:

Suite/Apt.

City:

State:

Zip:

* Email Address:

* Re-Enter Email Address:

* Daytime Phone: (xxx-xxx-xxxx)

Cell or Other Phone: (xxx-xxx-xxxx)

Fax Number: (xxx-xxx-xxxx)

* Description of Request: Please be as specific as possible: Be specific! Include address and owner of property, file name or number, time period, incident location and date, etc.

* Request from Government Agency?:

Yes

No

FEES: A fee of $0.50 per page will be charged for paper copies and/or scanning. An hourly fee of $23.72 per staff person to fulfill the request may also be charged for both electronic records and paper copies. If a city contractor is required to research records, the requesting party will be advised of the hourly rate for this service, charged to the city. The requesting party will be charged at the same rate as the city. For voluminous requests, staff will estimate the cost, which will be paid in advance as a deposit until the final payment amount is calculated.

STATEMENT OF PURPOSE

* Under Arizona Revised Statutes, Section 39-121.03, I state:

That the City records I requested will not be used for commercial purpose(s); or

That the City records I requested will be used for commercial purpose(s) (Monetary Gain):

(Commercial purpose is defined as: “The use of a public record for the purpose of sale or resale or for the purpose of producing a document containing all or part of the copy, printout or photograph for sale or the obtaining of names and addresses from public record for the purpose of solicitation or the sale of names and addresses to another for the purpose of solicitation or for any purpose in which the purchaser can reasonably anticipate the receipt of monetary gain from the direct or indirect use of such public record.” A.R.S. § 39-121.03 (D))

If for a commercial purpose, please explain intended use:

If you need further assistance, please contact the City Clerk's Office at (928) 341-8520.

Public Records Request

Requestor

Request