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2. Request for Release of Public Records for Non-Commercial Purposes
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6. Date of Request*
   Date of Request
8. Decedent Name*
9. OME Case #
11. Date of Birth
12. Date of Death
14. Requestor Name*
15. Are you Related to the Decedent?*
    -- Select One --YesNo
17. Relationship to Decedent
19. Phone Number*
20. Fax Number
22. Email Address*
24. Address*
26. City*
27. State*
28. Zip Code*
30. Medical Examiner Reports
    The Maricopa County Office of the Medical Examiner prepares different types of reports during a death investigation. These reports include: the Medical Examiner report, the Toxicology report, Anthropology reports, Neuropathology reports, and Odontology reports. Please be advised that not all of these reports will be completed on every case.
    
    The time required for the completion of reports will vary depending on the complexity, circumstances, and level of additional testing or investigation required for each individual case. We realize that families, friends, investigating agencies, and others desire timely closure of cases and receipt of our reports. Accordingly, we strive to close each and every case as soon as possible, while keeping in mind the importance of a thorough and complete death investigation and certification.
    
    The Office of the Medical Examiner follows retention schedule GS-1048 Rev 1 for Coroner/Medical Examiner Records, approved by the Arizona State Library, Archives, and Public Records. As such, records beyond the established retention period may not be available.
32. Coroner/Medical Examiner Records Retention Schedule
    GS-1048 Rev 1
34. Copy Requests and Fee
    Copies of report(s) are available to the public following the final completion of the case.
    
    If you request to receive the report(s) via email or fax, there is no fee.
    
    If you request to receive the report(s) via mail or pick-up, there will be a $5.00 fee. Exception: If you are the Next of Kin, the $5.00 fee will be waived.
36. Select Method to Receive Reports*
    -- Select One --Email (no fee)Fax (no fee)Mail (Fee: $5.00, no charge for Next of Kin)Pick-up (Fee: $5.00, no charge for Next of Kin)
38. If a Fee is Required, the Request will not be Processed without Prior Payment:
    Please PRINT the form and submit with payment to:
    
    Maricopa County Office of the Medical Examiner
    701 W. Jefferson Street
    Phoenix, AZ 85007
    
    Acceptable forms of payment include:
    
    Cashier’s check, money order, or business checks made payable to: "Maricopa County Office of the Medical Examiner".
    
    Personal checks will not be accepted.
    
    Credit or debit cards can be used for payment by calling 602-506-3322.
40. Statement of Non-Commerical Purpose*
    -- Select One --AgreeDo Not Agree

    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.
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44. 1. Receive an email copy of this form.
45. Email address

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