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
*
MM
/
DD
/
YYYY
Name
*
Your answer
Address
*
Your answer
Telephone Number
*
Your answer
Email Address
*
Your answer
Nature of Request
*
Opportunity to review records (no original record may leave the custodian's office).
Copies of records.
Please read and sign the following statement:
*
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):
*
Your answer
Signature (Please Print your Name as Your Signature):
*
Your answer
Liberty Elementary School District No. 25
Submit
Never submit passwords through Google Forms.
This form was created inside of Liberty Elementary School District.
Report Abuse
Forms