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2. Request is hereby made for the following public records:*
   Please indicate document names, page numbers, addresses, and/or permit numbers where applicable.
6. Commercial Purpose
   A "commercial purpose" is defined by A.R.S. Section 39-121.03 as the use of public records for:

   • Sale or resale, or to produce a document containing all or part of the record (such as a copy, printout, or photograph) for sale, or
   • Obtaining names and addresses from such public records for solicitation, or
   • For a purpose in which the purchaser can reasonably anticipate monetary gain from the direct or indirect use of such public record.
8. Pursuant to A.R.S. Section 39-121.03, the applicant certifies that said documents:*

   1. Will not be used for a commercial purpose.
   2. Will be used for a commercial purpose.

   Select one.
10. Which information will be used for commercial purposes?
    For example, phone numbers, addresses, etc.
12. This information will be used for:

    1. Sale or resale to a specific market.
    2. Production of a document or other material containing all or part of the information in the public record.
    3. Solicitation for donations or investments.
    4. Solicitation for a business or commercial relationship.
    5. Other
14. If you selected "other," please elaborate.
16. Please list any other pertinent information regarding your intended commercial use.
    Include the market, client, or customer you intend to sell to, and the estimated price or value of the requested information.
20. How would you like to receive your records?*

    1. Electronically, via email.

    1. By picking up a physical copy at Town Hall.
24. Fee Schedule
    Pinetop-Lakeside Consolidated fee Schedule

    Review the fees and payment policies that apply to all public records requests.

26. I agree to pay the Required Fees and Deposits, if any, for the requested information.*

    1. I agree.
30. First Name
31. Last Name
33. Mailing Address
35. City
36. State
37. Zip Code
39. Email Address
    Required if you wish to receive documents electronically.
41. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
43. Electronic Signature*
44. Date*
    Date
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field