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2. 
3. BLOOMFIELD POLICE DEPARTMENT

   Police Records Request FORM

   
   

5. Person Requesting Record
6. Date of Request
   Date of Request
7. Case Number
9. Address
11. Email Address
12. Phone Number
14. Type of Incident
15. Date & Time of Incident
    Date & Time of Incident

    Date & Time of Incident
16. Location of Incident
18. Name of Person Involved
19. Date of Birth of Person Involved
    Date of Birth of Person Involved
21. Applicant's Interest in This Incident
23. I am the:

    1. Arrestee
    2. Attorney for (please specify)
    3. Guardian for (please specify)
    4. Media Outlet (please specify)
    5. Suspect
    6. Victim
    7. Witness
    8. Other (please specify)
24. Please provide more information.
26. Source

    1. Email
    2. Fax
    3. Front Desk
27. Record Requested

    1. Body Worn Camera
    2. Dispatch Audio
    3. Local Background Request
    4. Location History Search
    5. Photo
    6. Report
    7. Video
29. Your signature below affirms that the requested information will not be used for solicitation of business for monetary or pecuniary gain and acknowledges that such a violation is a misdemeanor and is punishable by a fine and/or imprisonment and that any booking photograph requested will not be placed in a publication or posted to a website that requires the payment of a fee or other exchange for pecuniary gain in order to remove or delete the booking photograph from the publication or web site. CR.S. 24-72-305.5 Ii[ 24-72-309.
31. Signature
    Failure to sign will result in request not being fulfilled.
32. Date
    Date
34. Tech
35. Number of Pages
36. Date
    Date
37. Fees Due/Paid
39. Remarks
41. Released By
42. Date & Time
    Date & Time

    Date & Time
44. Delivery

    1. Pickup
    2. Pickup
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field