To Custodian of records of:
Human Resources / Benefits
Requester/Purchaser understands that Maricopa County does not guarantee the accuracy of the data and information requested and hereby expressly disclaims any responsibility for the truth, lack of truth, validity, invalidity, accuracy, inaccuracy of any said data and information. Requester/Purchaser accepts responsibility for Requester/Purchaser’s unauthorized use or transmission of any such data or information in its actual or altered form.
Non-Commercial Records Request
Request is hereby made to:
The Following Public Record(s):
(indicate document name, page numbers, address and permit number where applicable).
I agree to pay the applicable reproduction fee of the records as follows:
Please notify me of the full charge for the records before copying.
Not to exceed the following amount:
*Please Check This Box If You Have Already Contacted A County Employee Regarding This Request
City, State, Zip:
Pursuant to A.R.S. §39-121.03, I certify that the record(s) are requested for Non-Commercial Purposes ONLY.
WARNING: Arizona Revised Statutes §39-121.03(C) provides:
A person who obtains public records for commercial purpose without indicating the commercial purpose or who obtains a public record for a non-commercial purpose and uses or knowingly allows the uses of such public record for a commercial purpose or who obtains a public record for a commercial purpose and uses or knowingly allows the use of such public record for a different commercial purpose shall in addition to other penalties be liable to the state or the political subdivision from which the public record was obtained for damages in the amount of three times the amount which would have been charged for the public record had the commercial purpose been stated plus costs and reasonable attorney’s fees or shall be liable to the state or political subdivision for the amount of three times the actual damages if it can be shown that the public record would have not been provided had the commercial purpose of actual use been stated at the time of obtaining the records.
means the use of a public record for the purpose of sale or resale including any of the following:
Producing a document containing all or part of the copy, printout or photograph for sale, or
Obtaining of names and addresses from such public records for the purpose of solicitation or for creating a list for resale, or
For any purpose in which the purchaser can reasonably anticipate the receipt of monetary gain from the direct or indirect use of such public records. (A.R.S.§39-121.03(D)).
301 West Jefferson Street
Phoenix, Arizona 85003