Fillable PUBLIC RECORDS REQUEST FORM (Maricopa Association of Governments)

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PUBLIC RECORDS REQUEST FORM (Maricopa Association of Governments)

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TODAY ’S DATE:_______________________
PUBLIC RECORDS REQUEST FORM
YOUR NAME: PHONE NUMBER:
ADDRESS: City: State: Zip:
I hereby certify under penalty of perjury that the requested records
will not be used for commercial purpose as defined in ARS
§ 39-121.03
Your signature: _________________________________________________________________________________________ Date: __________________________________________________
The following information is needed before a records search can be conducted for your information.
PLEASE PRINT CLEARLY
If the record will be used for a commercial purpose, please state that purpose below:
I would like to: ( ) Review the requested documents ( ) Purchase existing documents ( ) Obtain photocopies of the requested documents
( ) Receive documents electronically
(Full documents priced individually.) (Copying charges will apply based on page size and color.)
Documents requested (please be as specific as possible):
REQUESTER, PLEASE DO NOT WRITE BELOW THIS LINE
Amount received $ _________________ Payment received in form of: Cash ____________ Check ____________ Other _________________
Employee(s) who filled this request:
Date request filled: ____________ ( ) Picked up by requester on _____________ ( ) Provided via e-mail ( ) Other _____________
DATE
( ) Enclosed is the record you requested. The record was not edited.
( ) Per Arizona Supreme Court guidelines, the attached record has been edited due to confidentiality rights of individuals named within.
The following information was redacted __________________________________________________________________________________
___________________________________________________________________________________________________________________
( ) No record was found based on the information you provided.
( ) Other
_____________________________________________________________________________________________________________
Revision Date: 9/25/19
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PUBLIC RECORDS REQUEST FORM (Maricopa Association of Governments)

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Completed 12 August 2020

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