Request Reports - Pinal County

Requestor Information
First Name:	Last Name:
Phone:	Email:

Address:
City:	State:	Zip:

Decedent Information
Relationship to Decedent:	Decedent Name:
Date of Birth (optional):	Date of Death (optional):
County of Death: Gila CountyPinal County
Pinal County Medical Examiner's Case Number (optional):

STATEMENT OF NON-COMMERCIAL PURPOSE Caution: Arizona Revised Statute 39-121.03 (C) provides: A person who obtains a public record for a commercial purpose without indicating the commercial purpose or who obtains a public record for a noncommercial purpose and uses or knowingly allows the use of such public record for a commercial purpose or who obtains a public record for a commercial purpose and uses or knowingly allows the use of such public record for a different commercial purpose or who obtains a public record from anyone other than the custodian of such records and uses it for a commercial purpose shall in addition to other penalties be liable to the state or the political subdivision from which the public record was obtained for damages in the amount of three times the amount which would have been charged for the public record had the commercial purpose been stated plus costs and reasonable attorney fees or shall be liable to the state or the political subdivision for the amount of three times the actual damages if it can be shown that the public record would not have been provided had the commercial purpose of actual use been stated at the time of obtaining the records. I hereby agree that the public records I have requested are not for a "commercial purpose" as defined by A.R.S. § 39-121.03, and will not be resold to any person at a cost based upon the value of the information contained in the public records.
Check here to indicate that you have read and agree to the terms of the Arizona Statute 39-121.03 (C), Statement of Non-Commercial Purpose.

Quick Launch