Online Public Records Request

This form is for non-medical related incidents.

Before you submit your request, please confirm the incident took place within the Arizona Fire & Medical Authority's jurisdiction. The Authority's service area currently includes the communities of:

Arlington | Arco | Buckeye Valley | Camelback Garden Farms | Coldwater Ranch | Corte Bella | Cross River | Dos Rios | Hopeville | Liberty | Litchfield Farms | Palo Verde | Pinnacle Peak County Island | Rainbow Valley | Rancho Cabrillo | Rancho Silverado | Rio Sierra | Savannah | Sunora | Sun City West | Sundero | Sun Lakes | Sundero | Tonopah | Valencia | Wittmann | Other areas of Maricopa County

If the incident did not occur within the above areas, please contact the fire/emergency medical services agency that responded to the incident.

Please Note: Active public records are in various locations within the Authority. The Authority requests that a reasonable amount of time be expected for responding to any request to copy or inspect Authority records. The Authority may require additional time to process more difficult requests and if so, an estimated time frame will be provided to the requestor. If requested information is deemed by the Authority to be archival in nature requiring staff time to research and acquire, such time will be reimbursable to the Authority by the requesting at a rate equal to the hourly salary of the person completing the research and retrieval.

Date *

Requestor's Full Name *

Business Name

Email Address *

Telephone Number *

Street Address *

City, State, Zip *

Date of Incident

Patient Name (if applicable)

Incident Address (or intersection)

City *

Specifically describe the record requested for review or copying: *

Indicate whether you wish to review/inspect or copy public records* * Copy
Review / Inspect

*Copy fees will be assessed as follows for non-commercial purpose requests: Black and white copy, letter size: $0.50 per page. Additional fees may be assessed for large volume copy jobs, color and/or oversize documents or they may be sent to a printer for cost plus 15% administration fee. Certification, long distance and mail or fax charges may also be assessed. A deposit may be required. Click here to view the Authority Fee Schedule.

Indicate whether you are using the public record for a commercial or non-commercial purpose* * Non-Commercial
Commercial

*A.R.S. 39-121.03D-Commercial purpose includes any 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 to another for the purpose of solicitation or for any purpose where the purchaser can reasonably anticipate the receipt of monetary gain from direct or indirect use of the record. When a person requests copies of Authority records for commercial purposes, a statement setting forth the commercial purpose for which the copies will be used must be provided.

I request the following public records which are maintained by the Arizona Fire & Medical Authority: (Indicate the type of record sought. Be as specific as possible. Include the document or materials’ name, type of media, e.g. paper, audio or video recording, etc., dates, page numbers, address, permit numbers and/or other identifying information.)*

By checking the box below, you acknowledge and agree to any and all fees related to the delivery and administration of this request for public records* * I Agree

Authority Fee Schedule

By checking the box below, I acknowledge that the Arizona Fire & Medical Authority 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 any said data and information. I further agree to hold the Arizona Fire & Medical Authority, its agents and employees harmless from any claims, causes of action or other liability that may arise as a result of furnishing these documents to me or as a result of my use or misuse of these documents.

Acknowledge * Yes

* - denotes required field