Request For Public Records
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LAKE HAVASU CITY CONSOLIDATED COURT
2001 COLLEGE DR. SUITE 148, LAKE HAVASU CITY, AZ 86403
(928) 453-0705
Fax (928) 680-0193
REQUEST FOR PUBLIC RECORDS
Person/Organization Requesting Record: _________________________________________________
Reason for Request: _________________________________________________________ _____ ___
Party Name: ________________________________________ Date Of Birth: ____________ ________
Case Number(s): ________________________________________________________________ _____
Daytime Phone Number: _____________ Email: _____
_____
______ Fax: ______________
Specific Documents or Information Requested: ____________________________________________
_____________________________________________________________________________________________
Are Certified Copies Requested? (Cannot Be Faxed or Emailed)
Yes
No
Delivery Method:
Mail
Pick Up
Fax (non certified)
Email (non certified)
Mail To (If Applicable) Address: _________________________________________________________
City: _________________________________________ State: _______________ Zip: _____________
Signature ____________________________________________ Date ___________________________________
PAYMENT METHOD:
CHECK
CASHIERS CHECK/MONEY ORDER
CREDIT CARD
CREDIT CARD AUTHORIZATION
Cardholder Name:
Cardholder Phone Number:
Credit Card Billing Address:
City:
State:
Zip:
Credit Card Number:
3 Digit Security Code:
Expiration Date:
Amount:
I Authorize the Lake Havasu Consolidated Court to Charge the above Credit Card
Cardholder Signature: ______________________________________ Date: ______________________________
Fees for information requested:
MUNICIPAL COURT
JUSTICE COURT
$17.00 Search Fee
$25.00 Search Fee
$ 0.50 per Page Copy Fee
$ 0.50 per Page Copy Fee
$17.00 Additional for Certified Copies
$25.00 Additional for Certified Copies
$25.00 Copy of Audio Tape
$25.00 Copy of Audio Tape
NOTICE OF DISCLAIMER: Lake Havasu Consolidated Court, responds to all requests for public records in accordance
with Lake Havasu City Code Chapter 2.24 and ARS § 39-101 et seq. Lake Havasu Consolidated Court, does not warrant
and shall not be responsible or liable for any loss, consequence, or damage resulting directly or indirectly from reliance
upon the accuracy, reliability, or timeliness of any record(s) provided pursuant to this request. Any person or entity relying
upon record(s) provided pursuant to this request does so at the person’s or entity’s own risk and assumes the
responsibility of verifying any information used or relied upon. The information provided is used by Lake Havasu City for
internal reference purposes.
Rev. 11/2014
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Parent category: Legal