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: Be specific! Include address and owner of property, file name or number, time period, incident location and date, etc.

* Requested By:

Law Enforcement Agency

General Public

* Report Number #:

Date/Time of Incident:

Location:

* Names of Involved Parties-Include Full Name(s) and DOB(s):Include Full Name(s) and DOB(s)

Call For Service/Event History
Fee $5 - A list of Calls For Service originating from a specific address during a specific time frame.

Location:

Date: From:

to:

NOTICE: A person who obtains a public record for commercial purpose without indicating the commercial purpose or who obtains a public record for a noncommercial purpose and uses or knowingly allows the use of such public record for a commercial purpose or who obtains a public record for a commercial purpose and uses or knowingly allows the use of such public record for a different commercial purpose or who obtains a public record from anyone other than the custodian of such records and uses it for a commercial purpose shall in addition to other penalties be liable to the state or the political subdivision from which the public record was obtained for damages in the amount of three times the amount which would have been charged for the public record had the commercial purpose been stated plus costs and reasonable attorney fees or shall be liable to the state or the political subdivision for the amount of three times the actual damages if it can be shown that the public record would not have been provided had the commercial purpose of actual use been stated at the time of obtaining the records. A.R.S. §39-121.03 (C)

Public Records Request

Requestor

Request