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Police Department FOIA Request Form

2. Requestor's Contact Information

4. First Name*

5. Last Name*

7. Home Address*

9. Home Address (Line 2)

11. City*

12. State*

13. Zip*

15. Phone Number

16. Email Address

18. Fax Number

20. Requested Information

22. Type of Record Requested*

    1. Incident Report
    2. Other

24. Date of Incident
    Date of Incident

25. Incident Number (If Known)

27. Location of Incident

29. Location of Incident (Line 2)

31. City

32. State

33. Zip

35. Names of Involved Parties (If Known)

37. Description of Incident

39. How would you like to receive the requested information?*

    1. Email
    2. U.S. Mail
    3. Fax

    Please be sure you have provided the necessary contact information above.

Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field