CITY OF PEORIA, ARIZONA
Request for Public Records 		ROUTED TO: ________________________
(A.R.S. Title 39)				   (Name & Department)


RETURN COMPLETED FORM TO RECORDS INFORMATION MANAGEMENT!!


Name:


Date:

NUMBER OF COPIES MADE

Agency Name:

Address:



Phone:

Email Address:

CHARGES ARE BASED ON FEES ESTABLISHED IN TABLES LISTED IN 
CHAPTER 2 OF THE PEORIA CITY CODE.

City:				State:		Zip:


TOTAL AMOUNT DUE


PLEASE NOTE: Active public records are in various locations 
within the City. The City requests that a reasonable amount of 
time be expected for responding to any request to copy or 
inspect City records. The City may require additional time to 
process more difficult requests and if so, an estimated time 
frame will be provided to the requestor.


Indicate whether you desire to inspect or copy public records

_____	Inspect

_____	Copy


Specifically describe the record requested for inspection or 
copying:
	

	

	

	

	

Indicate whether you are using the public record for commercial,
non-commercial or legal purposes.

_____	Commercial*

_____	Non-Commercial

_____	Legal



* A.R.S. 39-121.03D –Commercial purpose includes any 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 public records to another for the purpose 
of solicitation or for any purpose where the purchaser can 
reasonably anticipate the receipt of monetary gain from direct 
or indirect use of the record. When a person requests copies of 
City records for commercial purposes, a statement setting forth 
the commercial purpose for which the copies will be used must 
be provided.


Commercial Purpose Statement:



FOR RIM OFFICE USE ONLY


DATE RECEIVED: 				BY:

DATE PROCESSED: 			LOC:

LEGAL REVIEW REQUIRED:     Yes _____   No _____

REQUEST APPROVED:            _______

REQUEST DENIED:              _______



COMPLETION DATE/INITIALS


IMPORTANT NOTICE WITH RESPECT TO COPYRIGHTED MATERIALS

Under the copyright law of the United States (Title 17, United 
States Code) the making of photographs or other reproductions 
of copyrighted material. Under certain conditions specified in 
the law, libraries, archives and other holders of public records 
are authorized to furnish a photocopy or other reproduction. One 
of these specified conditions is that the photocopy or 
reproduction is not to be “used for any purpose other than private 
study, scholarship or research.” If a user makes a request for, or 
later uses, a photocopy or reproduction for purposes in excess of 
“fair use”, that user may be liable for copyright infringement. 
The City of Peoria, Arizona does not indemnify, nor holds harmless 
users of material produced pursuant to a Public Records request, 
nor grant exclusive use rights with respect to such material.  
Users who engage in excess of fair use may be subject to claims 
of copyright infringement. 

  

Rev: 07/08