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2. Note:

   To request a report involving a traffic crash please click HERE.

   This form is for Non-Traffic Crash reports only.

   
   

4. REQUESTOR DETAILS
6. Requestor's Name*
8. Requestor's Relationship to Incident*
   -- Select One --Involved PartyAttorney for Involved PartyInsurance Agency for Involved PartyMediaOther
10. Verification

    Please choose one of the following ways to verify your identity.

    1. Social Security Number
    2. Driver's License Number
12. Social Security Number:
14. Driver's License Number

    DMV Customer ID number listed on Driver's license or DMV ID card

16. Media Outlet

    If you are requesting this information as a member of the media please indicate which organization you are representing.

18. Client's Name
    If you are representing a person involved in the incident please list their name.
19. Claim Number

    If you have an insurance claim number related to this incident please list it here.

21. Attorneys:

    Please attach a letter of representation along with your request.

23. Insurance Companies:

    Please attach a signed release from your client indicating the Roanoke Police Department is authorized to release records to your company.

25. Other Relationship
27. Do you have the Incident Number(s)?*

    1. Yes

    1. No
29. Incident Number 1
30. Incident Number 2
31. Incident Number 3
32. Incident Number 4
34. Incident Street Address
    Please include street address if known
36. Date of Incident
    Date of Incident
    If known
37. Time of Incident
    Time of Incident
    If known
41. DELIVERY & BILLING ADDRESS

    Please let us know where you would like the requested information sent to if approved by the City Attorney. 

    This is also the address that will be billed for the associated costs. Please click here for additional information concerning related costs.

43. Address*
45. City*
46. State*
47. Zip Code*
49. Phone Number
51. Email Address
55. Instructions
    Please describe below the information you are requesting with as much detail as possible to ensure we provide you the correct information. If there is additional information not captured in the choices above (multiple dates, times, etc) please indicate that here.
57. Requested Information*
    Please be as specific as possible
59. Notice:
    Virginia Code Section §2.2-3706.1(D)

    As of July 1, 2022, criminal investigative files may only be released to certain parties, pursuant to Virginia Code Section § 2.2-3706.1(D):

    D. Criminal investigative files relating to a criminal investigation or proceeding that is not ongoing are excluded from the mandatory disclosure provisions of this chapter. but may be disclosed by the custodian, in his discretion, except as provided in subsection E; however such records shall be disclosed, by request, to (i} the victim; (ii) members of the victim's immediate family, if the victim is deceased and the immediate family member to which the records are to be disclosed is not a person of interest or a suspect in the criminal investigation or proceeding; (iii) the parent or guardian of the victim, if the victim is a minor and the parent or guardian is not a person of interest or a suspect in the criminal investigation or proceeding; (iv) an attorney representing a petitioner in a petition for a writ of habeas corpus or writ of actual innocence pursuant to Chapter 19.2 (§ 19.2-327.2 et seq.) of Title 19.2 or any other federal or state post-conviction proceeding; and (v) for the sole purpose of inspection at the location where such records are maintained by the public body that is the custodian of the records, an attorney who provides a sworn declaration that the attorney has been retained by an individual for purposes of pursuing a civil or criminal action and has a good faith basis to believe that the records being requested are material to such action.

63. // For Internal RPD Use Only //
    Please enter your PO# (4 digits only)
Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit

* indicates a required field