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

TO:


RETURN COMPLETED FORMS TO RIM 



NAME:

DATE:

NUMBER OF COPIES MADE

AGENCY NAME:
ADDRESS:


PHONE   
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 a commercial or 
non-commercial purpose.
  
 Commercial*
 Non-Commercial


* 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 pubic 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:                                    


REQUEST APPROVED:       

REQUEST DENIED:            


COMPLETION DATE/INITIALS
RIM	Rev: 2/03