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:

Security Measure