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Public Records Request Form

Public records for non-commercial purposes are provided at a cost of $.50 per page, plus certain staff costs. For charges related to commercial requests, the commercial value of the information, in addition to other related charges, will be assessed. (Please see the attached explanation for more detail.)

Please provide the information requested below. (If you do not have the necessary incident information, you may contact the Administration Office at (928) 537-5100.

Verified Statement of Commercial Purpose

Please return this form, along with your payment to:

Timber Mesa Fire and Medical District
Custodian of Records
3561 E Deuce of Clubs
Show Low, AZ 85901

Checks must be made payable to: Timber Mesa Fire and Medical District

COMPLETE THIS SECTION “ONLY IF” THE COPY REQUEST IS FOR A COMMERICAL PURPOSE
A.R.S. 39-121.03D-Commercial purpose includes any 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 to another for the purpose of solicitation or for any purpose where the purchaser can reasonably anticipate the receipt of monetary gain from direct or indirect use of the record. When a person requests copies of District records for commercial purposes, a statement setting forth the commercial purpose for which the copies will be used must be provided.
Please return this form, along with your payment to:
Timber Mesa Fire and Medical District Custodian of Records 3561 E Deuce of Clubs Show Low, AZ 85901 Checks must be made payable to: Timber Mesa Fire and Medical District I declare that I have read A.R.S. 39-121.01 (Non-Commercial Use) or A.R.S. 39-121.03 (Commercial Use) attached to this form and understand the contents therein.
FIRE DISTRICT USE ONLY