Rollinsford Police Department Report Request Form

Rollinsford Police Department

Report Request Form
Please complete the following for to request an accident report, incident report, arrest report or any other record. Fields marked with an * are required. The fee for an accident report is $20.00 and all other reports are $10.00. The fee must be submitted with this request. Once the report is cleared for distribution, a copy will be given to you or mailed. Open reports shall not be distributed until the investigation has been closed.
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
email address*
Report number
if known
Incident Date*

MonthDayYear
Date
Incident Location*
Record Type*

Accident ReportIncident ReportArrest ReportOther
Reason for Request*

Involved PartyLegal RepresentativeOther
Involvement*

Vehicle Operator/OwnerVictimDefendantWitnessParticipantOther
How would you like the requested report returned to you?*

Pick up at Police DepartmentMail
Signature

Clear
Today's Date

MonthDayYear
Should be Empty: