Law Enforcement Request Form: Access to Personal Information

Law Enforcement Request Form: Access to Personal Information

Law enforcement agencies should use this form when requesting information in the custody or control of Conservation Halton.
The following information is being requested under section 32(g) of the Municipal Freedom of Information and Protection of Privacy Act which allows for the disclosure of records containing personal information for the purposes of aiding a law enforcement investigation. Conservation Halton is permitted to disclose personal information to a law enforcement agency: (a) when legally required, (b) to aid a law enforcement investigation, and/or (c) for health and safety reasons.

If you require personal information for law enforcement purposes and you believe the information is in the custody or control of Conservation Halton, please complete this form.

Please Note: This form is not to be used for requests for third party or confidential information held by Conservation Halton. All such requests are to be referred to the Office of the President & CEO.
SECTION A: REQUESTER INFORMATION

This section is to be completed by the attending Law Enforcement Officer.
Agency Name:*
Agency Address:*

Street Address

Street Address Line 2

Municipality Province

Postal Code
Name of Person Requesting Access:*

First NameLast Name
Title:*
Badge/Identification No.:*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
SECTION B: SUBJECT INFORMATION
Subject Name:*

First NameLast Name
Date of Birth:

MonthDayYear
Date
Subject Address:

Street Address

Street Address Line 2

CityProvince

Postal Code
Agency’s Incident/File No.: *
Warrant of Apprehension No. (if applicable):
This request is being made pursuant to (legislation and section number):*
Description of information requested:*
Intended use of the information and relevance to the investigation:*
Type of access requested:*

Verbal/ViewingCopyOriginal Requested
Note: Original records will be released pursuant to warrant, subpoena, production order, or summons only.
SECTION C: ATTESTATION

Conservation Halton may be required to notify the subject regarding the provision of their information to law enforcement. By completing this form, you consent to this notification.
If you have an objection to this notification, please provide the reasoning below:
Certification
I, [Officer Name],* certify that:
1. The information above is accurate and correct, to the best of my knowledge;
2. I have the authority to collect the information requested on behalf of the agency noted for the purpose(s) specified; and
3. This information is requested in accordance with section 32(g) of the Municipal Freedom of Information and Protection of Privacy Act, as the information will aid in an investigation undertaken with a view for a law enforcement proceeding or from which a law enforcement proceeding is likely to result.
Signature of Investigating Officer:*

Clear
Date:*

MonthDayYear
Date
If you have any questions, please contact the Freedom of Information Coordinator at admin@hrca.on.ca or call 905-336-1158 ext. 2236.
NOTICE OF COLLECTION
Personal information contained in this form is collected pursuant to section 32(g) of the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purpose of responding to your request. Personal information is collected and managed in accordance with the Municipal Freedom of Information and Protection of Privacy Act.

Questions about the collection of information can be directed to the Freedom of Information Coordinator, Office of the President & CEO, 2596 Britannia Road West, Burlington, Ontario, L7P 0G3, 905-336-1158 ext. 2236, admin@hrca.on.ca.
Should be Empty:

Law Enforcement Request Form: Access to Personal Information

SECTION A: REQUESTER INFORMATION

SECTION B: SUBJECT INFORMATION

SECTION C: ATTESTATION

Certification

NOTICE OF COLLECTION