FOIA Request Form (Police Department Only)

2. REQUESTOR DETAILS

4. Requestor's Name*

6. Requestor's Relationship to Incident*
   -- Select One --Involved PartyAttorney for Involved PartyInsurance Agency for Involved PartyMediaOther

8. Media Outlet

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

10. Client's Name

    If you are representing a person involved in the incident please list their name.

12. Other Relationship

14. Do you have the Incident Number(s)?*

    1. Yes

    1. No
16. Incident Number 1

17. Incident Number 2

18. Incident Number 3

19. Incident Number 4

21. Incident Street Address

    Please include street address if known

23. Date of Incident
    Date of Incident

    If known

24. Time of Incident
    Time of Incident

    If known

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

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

30. Address

32. City

33. State

34. Zip Code

36. Phone Number

38. Email Address

42. 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.

    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.

44. Requested Information*

    Please be as specific as possible

48. // For Internal RPD Use Only //

    Please enter your PO# (4 digits only)

Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field