Records Request Form

California Government Code 6254(F), California Vehicle Code 20012, and other State codes are governed to limit those who are eligible to receive copies of police reports or other police records. Certain reports that contain arrest or juvenile information may be exempt from disclosure. Once request has been received, we will process your request within (10) business days. Records will contact you for eligibility and instructions on payment. Payment needs to be received prior to report release.

1. Contact Information (Requester)
Full Name Full Name * First Middle Last
Date of Birth Date of Birth / MM / DD YYYY
Email *
Phone Number Phone Number - ### - ### ####
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
2. Request Details
I would like to obtain the report by: *

I would like to obtain the report by: Email Postal Mail In Person
I am requesting the following: *

I am requesting the following: Police Report Citation Photos Fire Report Other Other
Do you have a case number? *

Do you have a case number? Yes No
Do you have a citation number? *

Do you have a citation number? Yes No
Do you have a fire report number? *

Do you have a fire report number? Yes No
Case #
Citation #
Fire Report #
Date of Incident Date of Incident / MM / DD YYYY
Time of Incident Time of Incident : HH MM AM/PM
Location of Incident
3. Electronic Signature
I certify that I am: *

I certify that I am: Named in Report An Insurance Agent From a Law Office Authorized From a Government Agency
Who is your insured? *
Who do you represent? *
Provide name of involved party *
Provide the agency name *
Verification Document *

Attach Files

Attach copy of your government issued photo ID
Verification Document *

Attach Files

Attach copy of your business card
Verification Document *

Attach Files

Attach signed waiver
Signature *

Draw or Type

I declare under the penalty of perjury, that I am the party of interest as checked above. Clear

Full Name

I declare under the penalty of perjury, that I am the party of interest as checked above.
Date Date * / MM / DD YYYY

Records Request Form

Records Request Form

1. Contact Information (Requester)

2. Request Details

3. Electronic Signature