ON-LINE 911 TAPE REQUEST FORM
(Fields with * are required)

  *Date of Request:      Date Needed: 
     (This is the date you are submitting the request)  (mm/dd/yy)          (This is the date you need the recording)  (mm/dd/yy)

   Trial Date (if applicable):  (mm/dd/yy)

  CONTACT INFORMATION

  *Name:        

  *Mailing Address:        

  *City, State:        

  *Zip Code:  

  *Daytime Phone: (include area code)        

    E-Mail Address: 

  *Preferred Recording Media:   Choose One Option .wav file sent via E-Mail CD (.wav file)

  *Information Requested: Telephone Traffic     Radio Traffic

        (check all that apply)

  *Incident Date:   (mm/dd/yy)

  *Incident Time:          (hh:mm  Indicate a.m. or p.m.)
     (This is for the date and time the incident occurred.  Be as specific as possible.  Incorrect or insufficient
    information may cause extensive research resulting in a significant delay as well as an increased cost
    for processing your request .)

  *Case/Incident Report Number:  
    (This is the identification number assigned to the police complaint.  This number can be obtained by calling the
     police agency involved in the incident)

  *Location of Incident:  
   (This section is for the location where the incident occurred.  Be as specific as possible.  Incorrect or insufficient information
     may cause extensive research resulting in a significant delay as well as an increased cost for processing your request .)

  *Type of Incident/Crime:  
   (This section is for what type of incident/crime occurred (e.g., domestic violence, assault, theft, motor vehicle accident, etc.)

    911 Caller's Name: (If known)

    Name(s) of Involved Person(s): (If known)
   

    Any other information that might be helpful in completing this request:
    

CAUTION:  The audio recording you are requesting may contain matters involving individuals' right to privacy, sensitive law enforcement matters, and/or vital governmental interests.  By submitting this form you are accepting responsibility for complying with all legal requirements concerning the use or disclosure of any information contained on the recorded media provided to you.