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Public Record Request

Type of Request

Please select the type of records requested: (select all that apply)  
Please explain your request for public records 
Provide as much information as possible including the names (producer, business, insurance company, financial institution, financial enterprise), license numbers and a range of dates for the records requested.

Commercial Purpose

Commercial purpose question: Do you or does anyone for whom you are acting as an agent intend to do any of the following with the public document(s) you are requesting.
Definition of Commerical Purpose

You have answered “Yes” to any of the preceding questions, your request is for a “COMMERCIAL PURPOSE.”

COMMERCIAL PURPOSE does not include the use of a public record as evidence or as research for evidence in any action in any judicial or quasi-judicial body. Pursuant to Arizona law, briefly describe the specific commercial purpose in the space below:

email, mail, certified

I am requesting that copies of this information be sent by
Mailing Address


CERTIFICATION: I have read and understand this form, including the provisions listed on the initial Public Records page found on the DIFI.Az.Gov. I certify that the information I have provided in this form is true and correct and that the records will not be used directly or indirectly for any purpose other than described above. I understand that I am responsible for paying all fees associated with this request before the requested records will be provided.
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Public Records Request