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Record Request Form (Online)

  1. Department Logo (Cropped)
  2. Records Request Form
    COST: .50 cents per page(8.5 x 11) $5.00 flat rate for requests by insurance companies (not including photos) $10.00 CD Additional fees may apply.Contact Records for rates specific to your request. **Report will be destroyed if it is not picked up within 14 days of notification**
  3. INSTRUCTIONS
    This form must be completed accurately.Your signature affirms that the requested information will not be used for a commercial purpose and acknowledges that such a violation is punishable by a civil penalty -A.R.S 39-121.03
  4. CHECK ONE: I am the*
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