FILE NUMBER     #    ______________ 
                                                                                                                 DO N   OT WRITE IN THIS  PACES        
                       State of Arizona – Office of the Secretary of State                                        
                       No Trespass Public Notice List                                                             
                       SEND BY MAIL TO:                                                                           
                        Secretary of State Michele Reagan, Atten: Business Services 
                        1700 W. Washington Street, FL. 7, Phoenix, AZ 85007-2808                                  
                       OR return this application in person:                                                      
                       PHOENIX - State Capitol Executive Tower,    TUCSON - Arizona State Complex,                
                       1700 W. Washington Street, 1st  Fl., Room 103   400 W. Congress, 1st Fl., Suite 141        
                       Office Hours: Monday through Friday, 8 a.m. to 5 p.m., except state holidays.              
                       PLEASE NOTE:  All information provided and attached to this form is public record.         
                       Information will be provided to the newspaper of public record in the county in which the  
                       employer is located. Every law enforcement agency in the state will be provided the No      
                        Trespass Public Notice list under A.R.S. § 23-1326.                                        FOR  FFICE O SE UNLYO    
                                                                                                                   NO TRESPASS  IST L EV R . 1/5/2015 
INSTRUCTIONS 
When to use this form: Employers shall use this form and supply              Recording Fees ~ A.R.S. § 23-1326(B): Fees are posted on our website, 
appropriate documents that establish the employer’s private property rights  under “Business Services.” 
to include the address or addresses and legal descriptions of the property   Website: All forms are available on the Secretary of State’s website, 
or properties to which it has legal control.                                 www.azsos.gov. 
How to complete this form: Review A.R.S. § 23-1326 found on our              Submission: Include all forms, documents and check or money order 
website under “Business Services.” Print clearly or computer generate this   and send by mail to the address above. 
form online. Use the supplement form to request more than one property       Questions? Call (602) 542-6187; in-state/toll-free (800) 458-5842. 
listing. Remember to attach copies of the documents that establish private 
property rights. 
1. Employer Information 
Business, Corporation or Company Name (as shown on legal documents) 

Employer Address 

City                                                                                          State                     Zip Code

 Employer representative 
First Name                        Middle Name (if used)            Last Name (if used)                           Title 

Phone Number (include area code)                Fax Number (include area code)              E-mail address 

County in which the employer is located 
 Check  Apache          Cochise              Coconino   Gila              Graham        Greenlee             La Paz              Maricopa
 One      Mohave          Navajo             Pima       Pinal             Santa Cruz    Yavapai              Yuma                  
 
2. Property Information     Number of properties to add to list                             If more than one property, attach supplement form. 
Property or Business Name (if applicable) 

Legal Description of the Property 

Property Address 

City                                                                            State         Zip Code                  Property Phone Number 

3. Attachments – Property rights documents shall include the address and legal description of the property to which the employer has legal control.
1. Type/description of document attached                                     2. Type/description of document attached 

3. Type/description of document attached                                     4. Type/description of document attached 

4. Employer’s Representative Signature – Must match the name in Section 1 of this form.
Signature                                                                                                                       Date 

 Print Form             Reset Form
Arizona Department of State                          Office of the Secretary of State                                   Michele Reagan, Secretary of State