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APPLICATION FOR RELEASE OF A POLICE REPORT/PUBLIC RECORDS/STATISTICS

  1. APPLICATION FOR RELEASE OF A POLICE REPORT/PUBLIC RECORDS/STATISTICS

  2. *PLEASE BRING A VALID FORM OF IDENTIFICATION WHEN PICKING UP REPORTS

  3. SPECIFY ONE:

  4. (If traffic Accident)

  5. (If Crime or Incident)

  6. CRIME, INCIDENT AND TRAFFIC COLLISION REPORTS WILL BE RELEASED TO INVOLVED PARTIES: VICTIM(S) of Crime, parent(s) or guardian(s) of juveniles, attorney(s) or authorized agents, representatives of insurance companies representing involved person(s), drivers or registered owners of vehicles or other parties who may incur a financial or civil liability) IF AUTHORIZED BY THE STATE LAW.

  7. IDENTIFICATION IS REQUIRED FOR ACCESS TO THESE RECORDS AND A FEE WILL APPLY

  8. 1. IF YOU ARE SEEKING RELEASE OF PUBLIC RECORDS, PLEASE CHECK THIS BOX AND PLEASE WRITE YOUR CONTACT INFORMATION BELOW. Release of PUBLIC RECORDS is covered under the CALIFORNIA PUBLIC RECORDS ACT, GOVERNMENT CODE SECTION 6250-6270. This request shall be processed within 10 days (or notified 14 day extension) from receipt of this request [GOVERNMENT CODE 6253(c)] upon payment of fees [GOVERNMENT CODE 6254(b)].

  9. 2. IF YOU ARE SEEKING ADDRESSES OF ARRESTED PERSONS OR VICTIMS OF CRIMES FROM THE PUBLIC LOG, PLEASE CHECK THIS BOX. Per Government Code 6254(3) and subject to the restrictions of section 841.5 of the Penal Code and this subdivision, the current address of every individual arrested by the agency and the current address of the victim of a crime, where the REQUESTER DECLARES UNDER PENALTY OF PERJURY that the request is made for a scholarly , journalistic, political, or governmental purpose, or that the request is made for investigation purposed by a licensed private investigator as described in chapter 11.3(commencing with section 7512)of Division 3 of the Business and Professions Code, except that the address of the victim of any crime defined by Section 220,261,261.5,262,264,264.1,273a,273d,273.5,286,288,288a,289,422.6,422.7,422.75,or646.9, of the Penal Code shall remain confidential. Address information obtained pursuant to this paragraph may not be used directly or indirectly, or furnished to another , to sell a product or service to any individual or group of individuals ,and the requestor shall execute a declaration to that effect under penalty of perjury. Nothing in this paragraph shall be construed to prohibit or limit scholarly, journalistic, political, or government use of address information obtained pursuant to this paragraph. THE REQUESTOR SHALL EXECUTE THIS DECLARION BY HIS/HER SIGNATURE BELOW.

  10. PLEASE SPECIFY FROM ABOVE:

  11. PLEASE COMPLETE THE SECTION BELOW

  12. (NAME)

  13. And that I have PROPER INTEREST in this report as one of the following:

  14. (Street, City, Zip)

  15. OFFICE USE ONLY

  16. Reason for Denial

  17. Requester Notified By

  18. Leave This Blank:

  19. This field is not part of the form submission.