PINAL COUNTY ELECTIONS
REQUEST FOR PUBLIC RECORDS
Name: Date:
Address:
E-mail address:
Phone: Home: Work:
Reason for Request:
□ Opportunity to review records (no original record may leave this office)
□ Copies of records
□ Other (please describe) ________________________________________
____________________________________________________________
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 will be charged for copying based upon actual cost for providing the
information.
Records Requested (please be as explicit as possible as to the records you are requesting)
MAIL TO: Pinal County Elections, P.O. Box 2209, Coolidge AZ 85128
Phone: 520 866-7550; Fax: 520 866-7551
Email: PCElections_DL@pinalcountyaz.gov
Website: http://pinalcountyaz.gov/elections/pages/home.aspx
FO
R OFFICE USE ONLY:
Date Completed: Completed By:
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