Request for Public Record
Note: It is not required by law that this form be filled out by a person requesting public records. The district may request the document to be filled out or the District may use the document internally as documentation of public records requests.
Notice: A fee will be charged for copying based upon actual cost for providing the information.
* Required
Date
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MM
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DD
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YYYY
Name
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Your answer
Address
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Your answer
Telephone Number
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Your answer
Email Address
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Your answer
Nature of Request
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Opportunity to review records (no original record may leave the custodian's office).
Copies of records.
Please read and sign the following statement:
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I have requested public records of the School District for a noncommercial purpose.
I have requested public records of the School District for a commercial purpose. I understand that if the records should be used for a commercial purpose, a verified statement of the purpose must be submitted per ARS 39-121.03.
Records requested (please be as explicit as possible as to the records you desire):
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Your answer
Signature (Please Print your Name as Your Signature):
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Your answer
Liberty Elementary School District No. 25
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