Public Records Request Form

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

1
Date
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2
Name (First and Last) 
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3
Business Name
4
Email
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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)
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8
If you are requesting Quarter Section maps, as-builts, or civil improvement plans please provide a Parcel Number (APN) or Address specifying the area of Interest.
9
 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):
10
 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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11
 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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