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Public Information Request

Police Department

FIRST & LAST NAME:
 
MAILING ADDRESS:
 
CITY:
 
STATE:
 
ZIP:
 
PHONE NO.:
 
Email:
  
Confirm Email:
 
NAME OF FIRM OR COMPANY REPRESENTING (if applicable):
 
INDICATE PREFERENCE: A COPY OR VIEWING/INSPECTING THE RECORD(S):
 
I AUTHORIZE A REDACTED VERSION OF THE RECORD(S) TO BE ACCEPTABLE (ie: Driver’s License, Social Security, and Vehicle License Plate number’s).

 
DESCRIPTION OF PUBLIC RECORD(S) BEING REQUESTED: Date of Incident (If exact date is unknown, please indicate month and/or year):
 
Incident #:
 
Person Involved:
 
I understand I am responsible for any applicable charges as a result of this open records request.
 

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