Liberty Elementary School District No. 25

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.

Date
Name:
Address:
Telephone Number:
Email Address:
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 commerical 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):
Notice: A fee will be charged for copying based upon actual cost for providing the information.
Signature:
	Please Print your Name as Your Sgnature

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