Request For Police Records Form - Chandler Police Department
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1Request for Police Records
Chandler Police Department
250 E. Chicago St. – Chandler, AZ 85225
Phone 480-782-4001
Information on this form will assist the Chandler Police Department to provide the public records you are
requesting. Under Arizona law, some information not subject to release may be removed or redacted from
records prior to release.
Requestor’s Information
(Please Print Legibly)
First Name
Middle Name
Last Name
Home Address
City
State
ZIP:
Primary Phone #:
Secondary Phone #:
Email Address:
Your relationship to the report (i.e. victim, suspect, driver, involved)
Date:
*Signature
*Under the provisions of ARS 39-121, the Public Records Law, I request the Chandler Police Department
provide a copy of the listed report/record to me. This report/record copy will be used solely for non-
commercial purposes.
Items Available for Request
(Subject to Availability)
Report Number:
If you do not have the Report Number, please provide all the information known, such as Name, DOB, Location and or Date and Time of Event to
identify and locate the report:
☐ $ 5.00 - Copy of Report
(Plus $0.15 per page after 35 pages)
☐ $ 0.00 - Copy of Report for Victims - No Charge
☐ $ 5.00 - Photographs
☐ $ 10.00 - 911 Recording
☐ $ 10.00 - Audio Recording
☐ $ 10.00 - Photo Red Light Request
☐ $ 25.00 - Video Recording
Mail - ☐
Call for Pick Up - ☐
E-Mail - ☐
Report Delivery Options:
Unclaimed copies will be destroyed 60 days after completion
Records Use Only
Date Received:___________________
Processed by: _____________________
Notification: ______________________
Receipt #: _______________________
Date Processed: ___________________
Date Notified: ____________________
Amount Received: ________________
Time Processed: __________________
Time Notified: ____________________
Employee #:_____________________
Original – Department
Copy – Requestor
01/14
46-26
F:Police/PD/Forms/Records/Request
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