Media Request for Police Related Records
First name:
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Last name:
*
Title:
Media Affiliation:
E-mail:
*
Street address:
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City:
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State:
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Zip:
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Phone Number
*
-
Area Code
Phone Number
What public record is being requested:
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DR# (if available):
Date and time of incident:
Incident type:
Other information that will be helpful in gathering records, such as officers who responded and/or parties involved:
Date needed:
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Month
-
Day
Year
Date
How would you like to receive the information?
Pick-up
Mail
Please type your initials here to show you have read and understand all the information above.
*
Submit
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