Timber Mesa Fire and Medical District – Public Records Request Information

1. Any person may request to examine or be furnished copies, printouts or photographs of any public record or other matter during regular office hours (8:00 a.m. to 5:00 p.m., Monday – Friday).
2. To request inspection and/or copies, printouts or photographs of public records or other matters, please complete the attached PUBLIC RECORDS REQUEST form and present it to the District custodian of records (“District Custodian”). Please be specific so that the records can be easily identified.
3. Public records may be located in various locations within the District. The request will be processed promptly based on the nature and extent of the request.  If more than ten (10) working days will be needed to process the request, you will be so notified.
4. Persons wishing to personally examine original records may be asked by the District Custodian to return at a mutually-convenient time between the hours of 8:00 a.m. and 5:00 p.m. during a week-day for that purpose.

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.

Checks must be made payable to:

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

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Public Records Request Form

Requestor Name (required)

Address (required)

City (required)

State (required)

Zip (required)

Telephone (required)

Fax

Email Address (required)

Request for (required)

Commercial

Non-Commercial

Under the provisions of A.R.S. §39-121, Public Records Law, it is requested that the following records be released (please be specific; attach list if necessary) (required)

Will you want copies? (required)

Yes

No

View Only? (required)

Yes

No

If copies are requested

Mail

Email (if available)

Pick Up

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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. If the request is for commercial purposes, please indicate how these records will be used

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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.

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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