Records Request Form - Newport Police Department printable pdf download

Records Request Form - Newport Police Department

NEWPORT POLICE DEPARTMENT

RECORDS REQUEST FORM

TO: _____________________________________

Date: _____________________

(Person in charge of record and department)

I request a copy of the following record (please provide sufficient information to identify the

specific document requested):

CASE NUMBER:

If any material contained in this request is exempt from disclosure, I understand you will provide the name

of the document and the reason for the exemption.

_________________________________

______________________________

(Name of Requestor)

(Address of Requestor)

_______________________________________

____________________________________

(Daytime Phone Number)

(Signature of Requestor)

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

(for office use only)

Your records request has been approved □ or denied □

Your request has been approved and the following estimated fees will be charged:

_________________________________________________________

$ __________

_________________________________________________________

$ __________

_________________________________________________________

$ __________

_________________________________________________________

$ __________

Fees paid: _____________________

TOTAL

$ __________

(date)

Your request has been denied based on all or part of the requested records exemption for the

following reasons:

_____________________________________

________________________________

(Custodian Name)

(Custodian Title)

_________________________________________

____________________________________

(Custodian Signature)

(Date)

Records Request Form - Newport Police Department

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