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2. CITY OF SHOW LOW, ARIZONA
   Request for Public Information
4. The following policies apply to all requests for materials/documents:
   1. Each request, after its receipt, is reviewed by the offices of the City Clerk and City Attorney. The requestor will be notified when the materials are available. Payment is due prior to receipt of the requested materials and/or information. 2. Materials may be faxed or emailed after payment has been received (including cost of transmission, if applicable). Materials requested to be mailed will be sent by first class mail after receipt of payment (including cost of postage). Make checks payable to the CITY OF SHOW LOW. 3. Charges for copies will be applied pursuant to a resolution of the Show Low City Council.
8. Date*
10. First Name*
11. Last Name*
13. Business Name
15. Address 1*
17. Address 2
19. City*
20. State*
21. Zip*
23. Phone Number*
24. Email Address*
26. Please describe the public records you wish to receive. In order to expedite the search for the records, please be as specific as possible. Include time period of records. *
28. Action Requested*

    Check all that apply

    1. Inspect
    2. Copy
    3. Certification
    4. Mail
    5. Email
30. Is this a commercial request?*

    1. Yes
    2. No

    COMMERCIAL PURPOSE means using a public record for the purpose of sale or resale, producing a document or photograph for sale, or obtaining names and addresses for solicitation or sale; or any purpose in which requester can reasonably anticipate receiving monetary gain from direct or indirect use of the public record. Commercial purpose does NOT mean using a public record as evidence or as research for evidence in any action in any judicial or quasi-judicial body.
32. Commercial purpose. Pursuant to A.R.S. Section 39-121.03(a), state in detail how or for what purpose the records will be used. *
34. All commercial requests must be notarized. If this is a commercial request, please PRINT the form, have it NOTARIZED, and SUBMIT VIA FAX to (928) 532-4009 or Email.

    Email address

36. Do you agree?*

    By clicking "I agree," you agree and acknowledge that 1) your application will not be "signed" in the sense of a traditional paper document and 2) by signing in this alternate manner, you agree that your "electronic signature" is valid and binding upon you to the same force and effect as a handwritten signature.

    1. I Agree
38. Signature of person making the request*
40. AFFIDAVIT (required for commercial records requests)
    Application for Public Records for Commercial Purposes
42. The undersigned, under oath, hereby deposes and states as follows in accordance with A.R.S. Section 39-121.03(a):
    That the foregoing Application for Public Records sets forth accurately the commercial purposes for which the public records will be used pursuant to A.R.S. Section 39-121.03(a).
44. Dated this ______ day of _______________, 20___.
46. Applicant's signature (sign in front of notary public)
48. STATE OF ARIZONA )
    County of Navajo )
50. This instrument was acknowledge before me this ______ day of ____________, 20____, by _______________________________.
52. _____________________________________________
    Notary Public
54. My Commission Expires:_________________________
58. FOR OFFICIAL USE ONLY
60. Received by:_________________________
61. Date received:________________
63. City Clerk__________
65. City Attorney__________
67. Building__________
69. Finance__________
71. Public Works__________
73. Other dept__________
77. Notification to Req.__________
79. Fee__________
80. Date paid__________
82. Picked up/Mailed/Emailed__________
Leave This Blank:


84. 1. Receive an email copy of this form.
85. Email address

    This field is not part of the form submission.

86. Submit Submit and Print

* indicates a required field