CCJRA Colorado Criminal Justice Records Act Request Form

The Mead Police Department is a criminal justice agency. Requests will be evaluated and responded to according to the appropriate applicable portions of C. R.S. 24-72-301 et. seq., which can differ from other evaluations, such as CORA, Discovery, or Subpoena. Based upon state and federal laws, all or some of the information may not be available for release. Copies may be obtained in person, by mail, by e-mail, or by fax. A minimum of three working days may be necessary to process your request and produce a copy of the report. A report may not be available prior to 10 days from the incident date. If you have not arranged or picked up the report within 14 days of the date the copy is made available, it will be destroyed.

Colorado C.R.S. 24-72-305.5 provides that the records custodian shall deny any person access to criminal justice records unless a statement is signed which affirms that such records shall not be used for the direct solicitation of business for pecuniary gain. I AFFIRM THATI SHALL NOT USE THE REQUESTED INFORMATION FOR SOLICITATION OF BUSINESS OR MONETARY/PECUNIARY GAIN AND ACKNOWLEDGE THAT SUCH VIOLATION IS A CLASS 3 MISDEMEANOR UNDER C.R.S. 24-72-305.5.

Electronic Signature - I am signing this document electronically and agree that my electronic signature is the legal equivalent of my handwritten signature on this document:

*A copy of your ID is requested to verify your identity and the legal attestation - You can attach it at the bottom of the form.

FULL NAME:

First Middle Initial Last

DATE OF BIRTH:

Month Day Year

DRIVER'S LICENSE # & STATE:

Number and State

MAILING ADDRESS:

Street, City, State, Zip

PHONE:

Phone number with area codeFormat: (000) 000-0000.

EMAIL:

example@example.com

OTHER PERSON(S) AUTHORIZED TO RETRIEVE ITEM(S):

Those allowed to retrieve items.

REQUESTER IS:

DATE OF INCIDENT

Month Day Year

TYPE OF INCIDENT:

CASE #:

YYML######

LOCATION/ADDRESS:

Intersection or address

WERE YOU INVOLVED:

IF NOT, LIST THE NAME(S) OF THOSE INVOLVED:

Full name(s) of involved persons

REQUESTED (CHECK ALL THATAPPLY):

ADDITIONAL INFORMATION:

Other specific requests

Upload a copy of your ID

Provide a legible copy of your government issued ID

Status of Request

COST:

DEPOSIT:

DEPOSIT PAID:

FULLY PAID:

DATE RELEASED/REFERRED/DESTROYED:

REQUESTER NOTIFIED:

EMPLOYEE NAME:

ADDITIONAL INFORMATION:

COLORADO CRIMINAL JUSTICE RECORDS ACT (CCJRA) REQUEST FORM

REQUESTING PERSON'S INFORMATION

INCIDENT INFORMATION

MEAD POLICE USE ONLY

COLORADO CRIMINAL JUSTICE RECORDS ACT (CCJRA) REQUEST FORM

REQUESTING PERSON'S INFORMATION

INCIDENT INFORMATION

*MEAD POLICE USE ONLY*

MEAD POLICE USE ONLY