Revised: 09/2019
LAKE HAVASU CITY MUNICIPAL COURT
2001 COLLEGE DR. SUITE 152, LAKE HAVASU CITY, AZ 86403 (928) 453-0748 Fax (928) 680-0193
REQUEST FOR PUBLIC RECORDS
Person/Organization Requesting Record: _________________________________________________
Reason for Request: _________________________________________________________ _____ ___
Party Name: ________________________________________ Date Of Birth: ____________ ________
Case Number(s): ________________________________________________________________ _____
Daytime Phone Number: _____________ Email: _____ _____ ______ Fax: ______________
Specific Documents or Information Requested: ____________________________________________
_____________________________________________________________________________________________
Are Certified Copies Requested? (Cannot Be Faxed or Emailed) Yes No
Delivery Method: Mail Pick Up Fax (non certified) Email (non certified)
Mail To (If Applicable) Address: _________________________________________________________
City: _________________________________________ State: _______________ Zip: _____________
Signature ____________________________________________ Date ___________________________________
PAYMENT METHOD: CHECK CASHIERS CHECK/MONEY ORDER CREDIT CARD
CREDIT CARD AUTHORIZATION:
I Authorize the Lake Havasu City Municipal Court to Charge the above Credit Card
Cardholder Signature: ______________________________________ Date: ______________________________
Municipal Court Fees for information requested:
$17.00 Search Fee, $0.50 per Page Copy Fee, $17.00 Additional for Certified Copies, $25.00 Copy of Audio Tape
NOTICE OF DISCLAIMER: Lake Havasu City Municipal Court, 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 Municipal Court, 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(s) provided pursuant to this request. Any person or
entity relying upon record(s) 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. The information provided is used by Lake Havasu City
for internal reference purposes.
Credit Card Billing Address:
