Public Records Request

Please indicate what type of public record you are requesting: *

The turnaround times for releasable materials may vary based on the complexity of the request and/or availability of records

Incident Report Number(s):

Name of Person(s) Involved:

Date of Incident:

Month

Day

Year

Location of Incident:

Other Details:

Pursuant to ARS 39-121.03, the applicant certifies that the documents (check one): *

Will NOT be used for commercial purpose

Will be used for a commercial purpose

If used for commercial purpose, a certified statement meeting requirements listed below the application must accompany the request.

Applicant Name *

Email Address *

Phone Number *

Today's Date *

Month

Day

Year

When the report is ready, how would you like to be contacted? (check one) *

Email

Phone

I certify that all information provided in this request is true and correct (type name) *