Arizona Department of State Public Records Reproduction Request Form , Secretary of State State of Arizona 226 Office of the Secretary of StatePublic Records Request SEND BY MAIL TO: Secretary of State 1700 W. Washington Street, FL. 7, Phoenix, AZ 85007-2808 OR return the form in person: PHOENIX - State Capitol Executive Tower, 1700 W. Washington Street, Fl., Room TUCSON - A rizona State Complex, 400 W. Congress, 1st Fl., Suite 1 Office Hours: Monda y throu g h Frida y , 8 a.m. to 5 p.m., except state holida y s.Website: www.azsos. g ov DO NOT WRITE IN THIS SPACE FOR OFFICE USE ONLY Public Records Request REV. //201 ~ PUBLIC RECORDS REPRODUCTION REQUEST ~ About this form Use this form to request a public record from our office underArizona Revised Statutes, Title 39, Ch. 1, Article 2 et seq.To assist our office in its effort to process your request, please bespecific and identify the document or record by name.How to complete this formThis form must be written (printed) legibly or computer generatedfor accuracy.For your convenience, this form has been designed to be filled outelectronically at our website and printed to your printer.Notarization is not required.Fees: Our office offers inspection of public records (A.R.S. 247 39-121) withreproduction of documents available at 10242 a page.The fee schedule for certified copies is posted on our website.Records or parts of some records may not be subject to publicdissemination under Arizona law. Our office will notify you if thereleasing of the record is restricted under law or if parts of the recordrequested will be redacted.If a document is available for public dissemination our office will contactyou about the copying fee associated with your request. Please remember our office may not be the custodian of the document or record you are requesting. We will make every effort to assist you with your request. 1.Document Information Check One Paper copy Certified Copy Electronic Copy Records inspection (in-person A.R.S. 247 39-121) Name of record or document (for example: loyalty oath, executive order, notice of appointment, limited partnership, campaign finance committee, etc.) Approximate date filed Name(s) of person(s) on the record or document Name of agency/person/business/committee filing the record Law, rule or statutory reference stating this document is filed with our office Please notify me to pick up this record in person I am requesting this information be sent by mail (additional fees may apply) 2.Use of Record 226 Review the laws on pa g e 2. I have reviewed and read the information on the back of this form. The requested records will be used for (check one): NON-commerical purposes. COMMERCIAL purposes. If you intend to use these documents for commercial purpose state the commercial purpose in the field below for which the above-requested public records will be used. A commercial use fee may apply. Commercial Use Disclosure Statement under A.R.S. 247 39-121.03 3.Contact Information First Name Last Name Mailing Address 226(include street or box number)CityState ZipCode Home Telephone # ( ) Fax Number (include area code) ( ) E-mail Address 4.Si g nature STATEMENT: I understand that the copy or other reproduction of the public record which I have requested is to be used solely for the purposes as stated on this form. I declare that such copies or reproductions will not be used directly or indirectly for a different purpose other than prescribed on this form. I understand that copying and/or postage fees may be associated with my request. SignatureDate Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Arizona Department of State Public Records Reproduction Request Form , Secretary of State State of Arizona Public Records Request Form Arizona Secretary of State222s Office PUBLIC RECORDS REPRODUCTION A.R.S. 247 39-121.01 (D)(1) 205223The custodian may require any person requesting that the custodian mail a copy of any public record to pay in advance for any copying and postage charges.224 A.R.S. 247 39-121.03 REQUEST FOR COPIES, PRINTOUTS OR PHOTOGRAPHS; STATEMENT OF PURPOSE; FEES A.A person requesting copies, printouts or photographs of public records for a commercial purpose shall, upon making such a request,provide a certified statement setting forth the commercial purpose for which the copies, printouts or photographs will be used.Upon being furnished the verified statement the custodian of such records may furnish reproductions, the charge for which shall include thefollowing:1.A portion of the cost to the state for obtaining the original or copies of the documents, printouts or photographs.2.A reasonable fee for the cost of time, equipment and personnel in producing such reproduction.3.The value of the reproduction on the commercial market.COMMERCIAL PURPOSE AS ABUSE OF PUBLIC RECORD; DETERMINATION BY GOVERNOR B.If the custodian of a public record determines that the commercial purpose stated in the verified statement is a misuse of publicrecords or is an abuse of the right to receive public records, the custodian may apply to the governor requesting that the governor byexecutive order prohibit the furnishing of copies, printouts or photographs for such commercial purpose. The governor, uponapplication from a custodian of public records, shall determine whether the commercial purpose is a misuse or an abuse of the publicrecord. If the governor determines that the public record shall not be provided for such commercial purpose he shall issue anexecutive order prohibiting the providing of such public records for such commercial purpose. If no order is issued within thirty days ofthe date of application, the custodian of public records shall provide such copies, printouts or photographs upon being paid the feedetermined pursuant to subsection A of this section.CIVIL PENALTY C.A person who obtains public records for a commercial purpose without indicating the commercial purpose or who obtains a publicrecord for a noncommercial purpose and uses or knowingly allows the use of such public record for a commercial purpose or whoobtains a public record for a commercial purpose and uses or knowingly allows the use of such public record for a different commercialpurpose or who obtains a public record from anyone other than the custodian of such records and uses them for a commercialpurpose shall in addition to other penalties be liable to the state or the political subdivision from which the public record was obtainedfor damages in the amount of three times the amount which would have been charged for the public record had the commercialpurpose been stated plus costs and reasonable attorneys' fees or shall be liable to the state or the political subdivision for the amountof three times the actual damages if it can be shown that the public record would not have been provided had the commercial purposeof actual use been stated at the time of obtaining the records.DEFINITION OF COMMERCIAL PURPOSE D.As used in this section "commercial purpose", means the use of a public record for the purpose of sale or resale or for the purposeof producing a document containing all or part of the copy, printout or photograph for sale or the obtaining of names and addressesfrom such public records for the purpose of solicitation or the sale of such names and addresses to another for the purpose ofsolicitation or for any purpose in which the purchaser can reasonably anticipate the receipt of monetary gain from the direct or indirectuse of such public record. Commercial purpose does not mean the use of a public record as evidence or as research for evidence inan action in a judicial or quasi-judicial body of this state or a political subdivision of this state.A.R.S. 247 39-122. Free searches for and copies of public records to be used in claims against United States; liability for noncompliance A.No state, county or city, or any officer or board thereof shall demand or receive a fee or compensation for issuing certified copies ofpublic records or for making search for them, when they are to be used in connection with a claim for a pension, allotment, allowance,compensation, insurance or other benefits wh