PUBLIC RECORDS REQUEST
All information provided on this form is subject to disclosure if requested
.
Requestor Name: ______________________________ Date: __________________
Address:_______________________________________________________________
(Additional fee will apply if records are to be mailed)
Telephone Number or Email
Address:_____________________________________
(To contact you if there are questions, delays, or records are ready for pickup)
Records Requested:
(Please be as specific as possible) A copying fee may be charged.
Is this a commercial request? Yes NO
(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 such public records for the
purpose of solicitation or the sale of such 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.” ARS 39-121.01).
If for a commercial purpose, please explain the intended use:
By submitting this request you certify that the foregoing information is true and correct to the
best of your knowledge. You further agree to pay all appropriate fees at the time the records are
delivered.
Please note: The Town will endeavor to fulfill requests “promptly”. However, records are stored
in various locations and some may contain confidential information that requires review and
possible redaction. Additional time may be necessary to process such requests.
For Office Use Only:
Date Fulfilled: _______
___
Number of Pages or Electronic File: __________
Amount Due: __________
Comments: (Reason records were withheld or redacted)
Email to dmiller@paradisevalleyaz.gov
