Media Records Request

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Please correct the field(s) marked in red below:

1
Date
 *
2
News Organization Name
 *
3
Name (First and Last) 
 *
4
Email
 *
5
Phone Number
 *
6
Mailing Address (Street Name & House Number, City and Zip Code)
 *
7
Under the provisions of A.R.S. § 39-121, it is requested that the following records be released: (Please be specific)
 *
8
 Indicate whether the record(s) is to be used for (see definition in Information and Instruction Sheet):
Indicate whether the record(s) is to be used for (see definition in Information and Instruction Sheet):
9
 These records will be used for the following purpose(s): (Please be specific. Please note that there are penalties associated with either using public records or allowing them to be used for a commercial purpose without declaring such intent on this request.)
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10
 I declare that I have read the Information and Instruction Sheet (or A.R.S. § 39-121.03 itself) and understand the contents herein. Under penalty of perjury, I declare the information I have provided is true and correct and that the records received pursuant to this request will not be used for a purpose other than has been identified herein.
 *
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