Yavapai County Sheriff’s Office
255 E. Gurley Street
Prescott, Arizona 86301
Sheriff Scott Mascher
Verified Statement of Non-Commercial Purpose
Public Data Request
Caution: Arizona Revised Statutes §39-121.03(C) provides:
“A person who obtains public records for a commercial purpose without indicating the commercial purpose or who
obtains a public record for a noncommercial purpose and uses or knowingly allows the use of such public record for a
commercial purpose or who obtains a public record for a commercial purpose and uses or knowingly allows the use of such
public record for a different commercial purpose or who obtains a public record from anyone other than the custodian of
such records and uses them for a commercial purpose shall in addition to other penalties be liable to the state or the political
subdivision from which the public record was obtained for damages in the amount of three times the amount which would
have been charged for the public record had the commercial purpose been stated plus costs and reasonable attorney’s fees
or shall be liable to the state or the political subdivision for the amount of three times the actual damages if it can be shown
that the public record would not have been provided had the commercial purpose of actual use been stated at the time of
obtaining the records.”
Record(s) requested:
List all requested information. The request must be legible and specific. Use additional sheet(s) if necessary.
Verified Statement
I hereby affirm that the public records I have requested are not for a “commercial purpose” as defined by A.R.S. §39-
121.03. I also hereby agree that the public records will not be transmitted or sold to any other person for a commercial
purpose.
Print Name (Must be legible)
Signature Date
Address (Please print – must be legible)
E-mail address (optional) Contact phone number
OFFICE USE ONLY
Paper copies Electronic copies
Number of pages:
Paper size:_
CD/Tape recording:
Other:
Total cost:
Date received: Date completed: _
Employee initial
click to sign
signature
click to edit
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