DLLC USE ONLY
Arizona Department of Liquor Licenses and Control
800 W Washington 5th Floor
License #
Phoenix, AZ 85007-2934
CSR
(602) 542-5141
PUBLIC RECORDS REQUEST
Pursuant to A.R.S. Title 39, Chapter 1, Public Records
NON-COMMERCIAL (Prices are subject to
# of pages
Cost
change)
____ Photocopies @ $ ____________ per page
$ ______________
1-10
No Charge
____ Board Hearing: Audio Recording- $10.00
$ ______________
11-25
$.10
____ Document Certification - $2.00
$ ______________
26-50
$.20
Total
$ ______________
51-75
$.30
COMMERCIAL* (Prices are subject to change)
76-100
$.40
____ Photocopies @ $_____________ per page
$ ______________
100 +
$.50
____Document Certification - $2.00 per
document
$ ______________
Total
$ ______________
*A.R.S. §39-121.03(D)
For the purpose of this section, "commercial purpose" means the use of a public record for the purpose of sale or resale or for the purpose of
producing a document containing all or part of the copy, printout or photograph for sale or the obtaining of names and addresses from public
records for the purpose of solicitation or the sale of names and addresses to another for the purpose of solicitation or for any purpose in which the
purchaser can reasonably anticipate the receipt of monetary gain from the direct or indirect use of the public record. Commercial purpose does
not mean the use of a public record as evidence or as research for evidence in an action in any judicial or quasi-judicial body
Please complete this section
1. Date of request: ________________________________ Deadline for response (if applicable): ________________________________
2. Requesting party’s name: _____________________________________________ Daytime Contact Number: ____________________
3. Requesting party’s email: ____________________________________________________________________________________________
4. Liquor License # ___________________________ Licensee/Agent name: ___________________________________________________
5. Owning entity name
: ___________________________________________________________________________
(L.L.C., Corporation, etc.)
6. Licensed location name: ____________________________________________________________________________________________
7. Licensed location address: ___________________________________________________________________________________________
8. Documents Requested:
9. Certify for court use?
10. Do you directly or indirectly intend to:
a) Sell or resell the documents?
b) Sell or resell any of the information contained in the documents?
c) Use any of the information contained in the public documents to produce a document for sale?
d) Use any of the names or other information from the public documents for the purpose of solicitation?
e) Do you anticipate receiving monetary gain from either direct or indirect use of the public documents?
8/20/2015
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Individuals requiring ADA accommodations please call (602)542-9027