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Request for Records

2. Case Number

   If Applicable

3. Date
   Date Start Date

   —

   Date End Date

5. Victim Name

6. Date of Birth
   Date of Birth

8. Complainant’s Name

10. Incident Address

    No P.O. Boxes

12. Address2

14. City

15. State

16. Zip

18. Type of Incident*

    Accident Report, Call for Service, Etc.

20. The requesting person is liable for any further dissemination of information contained in the report.

    The requesting person is liable for any further dissemination of information contained in the report.

22. First Name*

23. Last Name

25. Phone*

26. Email Address

28. Mailing Address

30. Address2

32. City

33. State

34. Zip

36. Processing Fees Breakdown
    <ul><li>Report (FOAA) 1-7 pages: $12 (each additional page after 7: $1)</li><li>Routine accident reports: $12</li><li>Color photos on printed paper: $2 each</li><li>Nonpaper requests (VHS,DVD,CD, Audiotapes): $25 each media form</li></ul>

    • Report (FOAA) 1-7 pages: $12 (each additional page after 7: $1)
    • Routine accident reports: $12
    • Color photos on printed paper: $2 each
    • Nonpaper requests (VHS,DVD,CD, Audiotapes): $25 each media form

38. Payment must received before a report can be released, unless other satisfactory arrangements have been made with the records clerk.
    <ul><li>Processing Time: 7-10 Business Days</li><li>Payments:<BR>Cash<br>Checks - Made to the Cumberland County Sheriff’s Office</li><li>Payment Due at Time of Pick-Up or Prior to Mailing</li><li>Available Pick-up Times: Monday - Friday: 8 a.m. - 4 p.m</li><li>Closed All Major Holidays</li></ul>

    • Processing Time: 7-10 Business Days
    • Payments:
      Cash
      Checks - Made to the Cumberland County Sheriff’s Office
    • Payment Due at Time of Pick-Up or Prior to Mailing
    • Available Pick-up Times: Monday - Friday: 8 a.m. - 4 p.m
    • Closed All Major Holidays

40. Please Note
    Some reports may not be available at the time of this request.

    Some reports may not be available at the time of this request.

42. Office Use Only

44. Paid

    1. Yes
    2. No

45. Receipt Number

46. Payment Method

Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit Submit and Print

* indicates a required field