PUBLIC RECORDS REQUEST

Statement of Commercial Purpose

Pricing Computation Worksheet

A commercial purpose is defined by A.R.S. §39-121.03 as the use of public record for the purpose of:

• The sale or resale or for the purpose of 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 a purpose in which the purchaser can reasonably anticipate the receipt of monetary gain from the direct or indirect use of such public record.

The specific information which will be utilized from the record(s) requested on                             (Date of Request) is:                                                                                       

Which will be used for:

1.      Sale or resale to                                                                                               (identify market) for

      $                            (price or cost) per                                    .

2.    Producing a document, information or other material containing all or part of the information in the public record: (Describe document or material and price)

3.      Solicitation to                                               (Identify market) for (what)                                                   or

$                            (price)

4.      Soliciting a business or commercial relationship. (Describe and give price or value)

5.      Other purpose: (Describe and give price or value)

_____    I agree to pay the fee of $                       for these records.

_____    I agree to pay the deposit of $                   for these records and shall pay the remaining balance of $           prior to receiving the requested record(s).

________________________________________                _________________

Applicant                                                                                Date