Arizona Office of Administrative Hearings

1. Date:

2. Public Records

From: 3. Last Name: 4. First Name:

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12. Placing a mark in the signature space below constitutes my certification that I have read the document and that the contents are true to the best of my knowledge or belief. I further certify that I have reviewed the definition of commercial and non-commercial purposes; that I understand the the cost of a copy reproduction is at $0.50/page for 8.5 x 11", or the cost incurred by the OAH for replication of oversized documents; and that the cost of replication must be paid prior to replication.
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