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2. A commercial purpose is defined by Arizona Revised Statute §39-121.03 as the use of a public record for the purpose of:
   •    The sale or resale or for the purpose of producing a document containing all or part of the copy, printout, or photograph for sale, or
   •    Obtaining of names and addresses from such public records for the purpose of solicitation, or
   •    Any purpose in which the purchaser can reasonably anticipate the receipt of monetary gain from the direct or indirect use of the public record

4. Name*
5. Title*

   Owner, Lienholder, CEO, etc.

7. Company Name*
9. Address*

   Location of business

10. Nature of Business*

    Engaged in the business of...

12. I am requesting to:*

    1. Inspect
    2. Reproduce
14. the following public record(s) of Graham County:*

    State record being requested.  Please be specific.

16. I do hereby certify that the public records, which I have requested, are for the following purpose(s):*
18. I certify that all information provided is true and correct and I agree to pay any applicable fees for these records.
20. 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.
22. Electronic Signature*
23. Date*
    Date
25. CONTACT INFORMATION:
27. Full Name*
28. Telephone Number*
30. Address*
32. Email Address*
34. CAUTION: ARIZONA REVISED STATUTES 39-121.03(C) PROVIDES:

    “C. A person who obtains a public record for a commercial purpose without indicating the commercial purpose or who obtains a public record for a noncommercial purpose and uses or knowingly allows the use of such public record for a commercial purpose or who obtains a public record for a commercial purpose and uses or knowingly allows the use of such public record for a different commercial purpose or who obtains a public record from anyone other than the custodian of such records and uses it for a commercial purpose shall in addition to other penalties be liable to the state or the political subdivision from which the public record was obtained for damages in the amount of three times the amount which would have been charged for the public record had the commercial purpose been stated plus costs and reasonable attorney fees or shall be liable to the state or the political subdivision for the amount of three times the actual damages if it can be shown that the public record would not have been provided had the commercial purpose of actual use been stated at the time of obtaining the records.”

36. DISCLAIMER-INDEMNIFICATION

    Requester understands and agrees that Graham County does not guarantee the accuracy of the data and information requested and hereby expressly disclaims any responsibility for the truth, lack of truth, validity, invalidity, accuracy, or inaccuracy of said data and information. Requester agrees to indemnify Graham County, its officers and employees from any liability which may arise from the Requester’s unauthorized use or transmission of any such data or information in its actual or altered form.

38. Please re-enter your email address below and make sure the "Receive an email copy of this form" box is checked. It's important that you receive a confirmation email after you hit the "Submit" or "Submit and Print" button below. Thank you!

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40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

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