Middleton Police Department - Open Records Request

Middleton Police Department - Records Request Form

The Records Department will complete your records request as soon as practical and without delay. If you have questions, you can contact the Records Department at (608)824-7360 or PoliceRecords@MiddletonPD.com.

Date of Request

Date

Requester Name and Company

Requester Phone #

Format: (000) 000-0000.

Requester Email

example@example.com

Requester Address

Street Address

Street Address Line 2

CityState

Zip Code

Record to be picked up by Requestor, emailed or mailed to above address

Type of records sought (include as much detail as possible)

Dates and Times of records sought, if known

Date

Hour MinutesAM/PM Option

Incident or Case Number(s) sought, if known

Incident Location of records sought, if known

Name and date of birth of person(s) about whom records are requested, if known

In regard to the record(s) you are seeking, are you a(n):

If the record(s) you seek contains video or audio content, select the appropriate choice:

*Per WI Statute 19.35(3), any individual providing false certification that they will not use the requested records disclosed for financial gain shall be subject to a forfeiture of $10,000 for each violation.

*Fees may be imposed upon a requester for the actual, necessary, and direct cost of redacting, whether by pixelization or other means, recorded audio or video content to the extent redaction is necessary to comply with applicable constitutional, statutory, or common law.

I certify that the information and statements on this request are true and correct and understand that the unauthorized disclosure of information obtained from these records for a purpose other than stated on this request form, or the sale or other distribution of the information to a person or organization not disclosed in this request, may result in civil and criminal penalties imposed under Title 18 U.S.C. Section 2724.

I further understand that I have the right to request a mandamus review of the responses provided to this request under Wisconsin Statute Section 19.37(1).

Requester Signature

Date signed

Date

Please verify that you are human