Report Release Form

Name of Applicant/Company Requesting Report:

Phone Number

Driver's License #

Driver's License State

Date of Request:

Address

Address 2

City

State

ZIP

Type of Report/Inquiry/information requested/appropriate date(s) to assist with search:

Report Number (if known):

The fee for each police report is $.50 for the 1st page and $.10 for each subsequent page.

IN ACCORDANCE WITH GOVERNMENT CODE SECTION 6256, THIS REQUEST WILL BE PROCESSED WITHIN 10 DAYS. AS THIS DEPARTMENT RELEASES INFORMATION ONLY AS REQUIRED BY STATUTE, PORTIONS OF THE REPORT MAY BE WITHHELD PURSUANT TO THE GOVERNMENT CODE, PENAL CODE, WELFARE AND INSTITUTIONS CODE, VEHICLE CODE, OR THE CALIFORNIA CONSTITUTION.

I am able to provide required identification to certify that I am:

An involved party

A parent or guardian of juvenile victim

A separate juvenile application and the juvenile's birth certificate are required

An authorized representative or insurance carrier of involved person

An attorney of involved party and possess a waiver

A member of the public requesting releasable information

THIS REPORT IS AN INVESTIGATIVE REPORT INVOLVING BODILY INJURY OR PROPERTY DAMAGE AS THE RESULT OF ARSON, BURGLARY, FIRE, EXPLOSION, ROBBERY, THEFT, VANDALISM, A CRIME OF VIOLENCE AS DEFINED IN PENAL CODE SECTION 13960(B), OR A TRAFFIC COLLISION REPORT. THE REPORT IS SUBJECT TO CHANGE AS NEW INFORMATION IS RECEIVED, AND ONLY AUTHORIZED PERSONS MAY LEGALLY POSSESS THIS INFORMATION.

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