4. Dear Maricopa County Attorney’s Office Custodian of Records:
6. This request is hereby made to...*

   1. inspect...
   2. reproduce...
8. ...the following public record(s):*
10. Optional File Upload
11. Additional File Upload
13. Pursuant to A.R.S. § 39-121.03, I certify that the record(s) are requested for (select one): *

    1. Non-commercial Purpose Only
    2. Commercial Purpose❖
15. ❖ A person who obtains public records for a commercial purpose without indicating the commercial purpose or who obtains a public record for a non-commercial purpose and uses or knowingly allows the uses 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 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. A.R.S. § 39-121.03.
17. I certify that all information provided on this form is true and correct. I agree to pay the applicable reproduction fee of the records or be notified to make an inspection appointment. I agree not to hold Maricopa County liable for any inaccurate or incomplete information I may receive.

19. The information submitted in this form may constitute a public record as defined in A.R.S. § 41- 151, and may be subject to inspection by or disclosure to third parties upon request for commercial or non-commercial use in accordance with A.R.S. § 39-121 et al.

21. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
23. Electronic Signature*
24. Date*
    Date
26. Name
27. Email Address*
29. Address
31. City
32. State
33. Zip Code
35. Phone Number
37. Revised February 2021
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39. Submit

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