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Public Records Reproduction View Request Form. This is a Arizona form and can be use in Liquor Licenses And Control Statewide.
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Tags: Public Records Reproduction View Request, LIC0109, Arizona Statewide, Liquor Licenses And Control
ARIZONA DEPARTMENT OF LIQUOR LICENSES & CONTROL
400 W Congress #521
Tucson AZ 85701-1352
(520) 628-6595
800 W Washington 5th Floor
Phoenix AZ 85007-2934
(602) 542-5141
PUBLIC RECORDS REPRODUCTION/VIEW REQUEST
Pursuant to A.R.S. Title 39-121.03
DO NOT WRITE IN THIS AREA – DEPT. USE ONLY
NON-COMMERCIAL (Prices are subject to change)
No. of Copies
Photocopies @ $
per page
$
1 - 10
11 – 25
Board Section: Cassette Reproduction $10.00 per cassette $
26 - 50
51 – 75
Document Certification: $2.00 per document
$
76 –100
100+
LICENSE #
Cost
No Charge
$.10 per page
.20 per page
.30 per page
.40 per page
.50 per page
COMMERCIAL* (Prices are subject to change)
Photocopies @ $
per page
Document Certification: $2.00 per document
LICENSE #
Total:
$
$
$
COMPLETE THIS SECTION
1. Please check the appropriate box:
Copy Request
View Only – No Copies
2. Date:
3. Name of requesting party:
4. Liquor License #:
5. Licensee/Agent Name:
Last
First
Middle
6. Corporation Name:
7. Business Name:
8. Documents Requested:
9. Certified for court use?
YES
NO
10. Do you directly or indirectly intend to:
YES
YES
YES
YES
YES
a) Sell or resell the documents?
b) Sell or resell any of the information contained in the documents?
c) Use any of the information contained in the public documents to produce a document for sale?
d) Use any of the names or other information from the public documents for the purpose of solicitation?
e) Do you anticipate to receive monetary gain from either the direct or indirect use of the public documents?
NO
NO
NO
NO
NO
*A.R.S. §39-121.03(D)
For the purpose of this section, "commercial purpose" means the 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 for the purpose of solicitation or the sale of names and addresses to another for the purpose of
solicitation or for any purpose in which the purchaser can reasonably anticipate the receipt of monetary gain from the direct or indirect
use of the public record. Commercial purpose does not mean the use of a public record as evidence or as research for evidence in an
action in any judicial or quasi-judicial body.
lic0109 05/2005
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