Middleton Police Department - Open Records Request

Middleton Police Department - Records Request Form

The Records Department is typically able to complete a records request as soon as practical and without delay, generally within 10 days. If you have questions, you can contact the Records Department at (608)824-7360 or PoliceRecords@MiddletonPD.com.

Date of Request

Date

Requester Phone #

Requester Email

example@example.com

Requester Name and Company

Requester Address

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

Type of records sought (jnclude 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

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*