Town of Quartzsite
P.O. Box 2812 / 465 N. Plymouth Avenue Quartzsite, Az. 85346
928-927-4333 Fax 928-927-4400
PUBLIC RECORDS REQUEST
(A.R.S. Title 39)
Name _________________________________________ Date________________________
Address _____________________________________ Phone _________________________
City ____________________ State ____ Zip _____________ Amount Due:$ ____________
Please Note: Active public records are in various locations. The Town request that a reasonable amount of time be expected for responding to any request to copy or inspect Town records. The Town may require additional time to process more difficult request 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
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Indicate whether you are using the public record for a commercial or non-commercial purpose:
______ Commercial* ______ Non-Commercial |
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Specifically describe the record requested for inspection or copying: __________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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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 reasonable 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. |
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Commercial Purpose Statement:
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FOR RIM OFFICE USE ONLY:
DATE RECEIVED: _______________________ BY: _____________
DATE PROCESSED:_________________________ BY:____________
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REQUEST APPROVED: ________
REQUEST DENIED: _________
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