Request for Police Records

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Use this form to request all types of police records, including traffic collision reports, from the ��ϲ� (��ϲ�) Police Department. To request records, this form must be filled out completely. If you are authorized by law to receive a copy of a ��ϲ� Police Department record, your request will be accepted and processed.��

In accordance with the California Public Records Act, you may expect to receive a response within ten (10) business days (Government Code��§ 7920.000 et seq.). Traffic collision reports may only be released to persons of proper interest as permitted by law (Vehicle Code��§ 20012).��

A fee may be associated with producing some records, including electronic records. The requestor will be notified of any potential costs before production of the record(s) and will be responsible for paying all fees prior to the release of the record(s) (Government Code §§ 7922.530 & 7922.575).��

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This form is for ��ϲ� Police Department records only.

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Requestor Information

First Name

Middle Name

Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Driver License / I.D. Card Number

Driver License / I.D. Card State of Issue

Primary Phone Number

Secondary Phone Number

Email Address

Involvement in the Case

Report / Incident / Record Information

Report / Incident Number(s) (N/A if not applicable)

Date of incident(s)

Time of Incident(s)

Specify EXACTLY which record(s) you are requesting and the reason for the request:

Fulfillment & Delivery

How would you like the report(s) to be delivered?

Acknowledgement

I CERTIFY UNDER PENALTY OF PERJURY (PENAL CODE § 118) THE INFORMATION PROVIDED IN THIS REQUEST IS TRUE AND CORRECT.

I UNDERSTAND A COST MAY BE ASSOCIATED WITH PRODUCING SOME RECORDS AND I WILL BE NOTIFIED OF ANY POTENTIAL COSTS AND RESPONSIBLE FOR THEM (AS ALLOWED BY GOVERNMENT CODE § 7922.530).

Signature (Type Your Full Name)

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This form is for �������ϲ� Police Department records only.