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911 Record Request Form
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This form has been modified since it was saved. Please review all fields before submitting.
Requesting Party
*
Calling Party
Citizen
Court System
Defendant
Defense
DSS Agent
EMS/Fire Agency
Law Enforcement
News Media
Private
Prosecution
Other
Caller Name (If Known)
Incident Number if Known
Incident Location / Address
*
Date of Request
*
Date of Request
Date Needed by
Date Needed by
Incident Time & Date
Incident Time & Date
Incident Time & Date
Time Span
Time Span Start Date
—
Time Span End Date
Type of Request
*
CAD Report (Most Popular)
Phone Recording*
Police / Fire / EMS Radio Recording*
* Any audio (Radio or Phone) is ONLY maintained for approximately 30 days from date of call
Duration of Radio Recording
-- Select One --
Dispatch Only
Under Control or Suspect in Custody
Until Units Arrive
When requesting a copy of radio traffic, please specify how far into the incident you need, i.e., Dispatch only; until units arrive on scene; until the incident is "under control" or suspect is in custody, etc.
Requested By - Name
*
Phone
*
*Email
*Required if sending electronic files
Reason for Request
*
I, the undersigned, understand that this is a copy of an original confidential tape, and certify that it will not be reproduced or used for reasons other than those documented by this authorization. I also am aware that there is a $0.25 per page fee for CAD reports, $0.50 fee for a CD, emailed files remain free.
Signature
*
Date
*
Date
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Email address
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