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Records Request Form

Records Request Form

In accordance with the Public Records Act/California Vehicle Code, I request to obtain a copy of the following report:

Report Number:        Date of Report: 

Report Type: Accident    Burglary/Theft    Other:  

Names of Subjects Involved

   Drivers: 

   Victims: 

   Suspects: 

 

I Certify that I am: 

    Authorized representative for: 

Purpose of Request (A complete explanation is required)

I understand the following:

  – The Public Records Act authorizes the Escalon Police Dept. to censor the report as they deem necessary.

  – I will be required to provide proof on my identification.

  – I will be required to purchase the report.

       The fee for collision reports is $20.00

       The fee for non-collision reports is $20.00

  – Completion of this request does not guarantee my entitlement to the above report. If this report is requested under the Public Records Act, I will be notified in approximately two weeks regarding the approval or denial of this request

  – If my request is denied, the reason for denial will be provided, if desired.

               I have read and understood the above

*YOU WILL BE NOTIFIED WHEN YOUR REQUESTED DOCUMENTS ARE READY TO BE PICKED UP*

RECORDS NOT PICKED UP AFTER 30-DAYS WILL BE DESTROYED AND MUST BE RE-REQUESTED

 

Requestor Information

Name: 

Address: 

Phone Number: 

Date of Request: 

          

      



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