Application for Release of Police Report

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Incident Information

Report Type

Traffic Collision

Crime/Arrest

Other

Case/Report Number

Date of Occurrence (if known)

Location/Address of Incident

Requestor Information

Name and/or Agency*

Representing (if applicable)

Address (Include City/St/Zip)*

Phone*

Fax

Email*

Involvement

Victim

Suspect/Arrestee

Insurance Company/Claims Adjuster

Parent/Guardian of Juvenile Party

Authorized Representative (Written Auth is Required)

Driver

Property Owner

Attorney

Other Party of Interest (specify)

Other

File Upload for ID Verification*

Certification

I declare under the penalty of perjury that:*

I am

I represent

I am an attorney representing the party of interest identified in the record requested hereon.

Date and Time of Request*

Signature*