CITY OF PEORIA, ARIZONA
Request for Public Records 		     
(A.R.S. Title 39)


								ROUTED TO:
	         
RETURN COMPLETED FORM TO THE OFFICE OF THE CITY CLERK
8401 W Monroe St, Peoria, Arizona, 85345, Phone 623 773-7340 Fax 623-773-7304


Name:


Date:


Agency Name:


Address:


City:				State:			Zip:


Phone:


Email Address:




CHARGES MAY APPLY AND WILL BE BASED ON ESTABLISHED FEE TABLES LISTED IN CHAPTER 2 
OF THE PEORIA CITY CODE.



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.


Inspection or Copy (required field)

Indicate whether you desire to inspect or copy public records

Inspect		or	Copy


Request Type (required field)

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

Commercial*	or	Non-Commercial		or	Legal


Specifically describe the record requested for inspection or copying:

	

	

	

	

	

	

*Commercial Purpose Notice:  A.R.S. 39-121.03D – For the purposes of this section, 
"commercial purpose" means the 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 for the purpose of solicitation or the sale of names and addresses to another 
for the purpose of solicitation or for any purpose in which the purchaser can 
reasonably anticipate the receipt of monetary gain from the direct or indirect use of 
the public record. Commercial purpose does not mean the use of a public record as 
evidence or as research for evidence in an action in any judicial or quasi-judicial 
body.

Any person who requests a public record for a commercial purpose and fails to indicate 
such shall be liable to the City of Peoria for three times (3x) the value of the record 
provided, plus costs, and attorney fees.


* Commercial Purpose Statement (Please complete this area to describe the Commercial 
Purpose use of the requested records.)








Signature* (required field)   




*The requestor affirms that he/she is the person as identified in the “Requestor” field 
and that the information requested will be used for the sole purpose as indicated in 
the “Request Type” field.
 

Copyrighted Materials Notice (Title 17, United States Code)

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: 11/11