Fillable PUBLIC RECORDS REQUEST (Lake Havasu City)

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PUBLIC RECORDS REQUEST (Lake Havasu City)

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N LAKE HAVASU CITY
PUBLIC RECORDS REQUEST
REQUESTOR NAME: BUSINESS NAME:
EMAIL ADDRESS: PHONE NUMBER:
MAILING ADDRESS: CITY: STATE: ZIP:
Records Requested: (Be as specific as possible. One request per form.)
A. Will the record be used in a claim against the United States? YES NO
B. Will the record be used for a commercial purpose of monetary gain? YES*
NO
*If you answered “YES,” provide a statement setting forth the commercial purpose for which the records will be used.
You will also be charged fees in accordance with ARS § 39-121.03:
Lake Havasu City, including its departments, agencies, boards, commissions, officers, officials, agents, volunteers, and
employees, does not warrant and shall not be responsible or liable for any loss, consequence, or damage resulting
directly or indirectly from reliance upon the accuracy, reliability, or timeliness of any record provided pursuant to this
request. Any person or entity relying upon record provided pursuant to this request does so at the person’s or entity’s
own risk and assumes the responsibility of verifying any information used or relied upon. Lake Havasu City is not
required to create records to satisfy a request and requestors only have the right to receive records that are already in
existence and in the format in which they are currently kept.
PLEASE INDICATE YOU HAVE READ THE DISCLAIMER DATE:
ABOVE BY CHECKING THIS BOX:
RPR-GEN Rev 9/19
Email to: cityclerk@lhcaz.gov
PRINT FORM
2330 McCulloch Boulevard N. | Lake Havasu City, AZ 86403-5950 | Phone (928) 453-4142 | www.lhcaz.gov
For Internal Use Only
REQUEST NO.:
Lake Havasu City, Arizona, responds to all requests for public records in accordance with Lake Havasu City Code
Chapter 2.24 and ARS §§ 39-101, et seq. Lake Havasu City charges a fee for duplication of public records.
For a list of current fees and charges, contact the Lake Havasu City Clerk’s Office at (928) 453-4142.
DISCLAIMER
PRINT FORM
Department(s) Assigned to: Completed by:
Completion Date: # of pages Fees due: $
Comments: No record(s) found based on the information provided. The following record(s) were provided:
Delivered via: E-mail Pick-Up Fax Mail
FOR OFFICE USE ONLY
RPR-GEN Rev 9/19
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PUBLIC RECORDS REQUEST (Lake Havasu City)

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Completed 3 August 2020

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