Request For Police Records Template printable pdf download

CITY OF DETROIT

Michigan Freedom of Information Act (FOIA) Request for

POLICE RECORDS

Please note that failure to complete certain fields on this form may result in a denial of your request.

1. Individual making this request: ________________________________________________________

2. Street address: _____________________________________________________________________

City/State/Zip: ______________________________________________________________________

Telephone number: _________________________ Fax number: ____________________________

Email address: _____________________________________________________________________

3. Your client or insured (optional ): _____________________________________________________

4. Type of record requested: ____________________________________________________________

5. Name referred to in record: ___________________________________________________________

6. Description/Nature of the incident: _____________________________________________________

7. Date and time of incident, if any, or period of time: _______________________________________

8. Detroit address or intersection of incident, if any: ________________________________________

9. Any other information that will assist the Police Department in locating the requested record:

__________________________________________________________________________________

I acknowledge that if this request is made within 30 days of a motor vehicle accident report being filed, I am

prohibited from doing the following: using the report for any direct solicitation of an individual, vehicle

owner, or property owner listed in the report, or disclosing any personal information contained in the report

with a third party for commercial solicitation of an individual, vehicle owner, or property owner listed in the

report until 30 days after the date the report is filed.

Signature: ____________________________________ Dated: _________________________________

NOTE: 1) Failure to complete this form may result in a denial of your request.

2) If the requested record pertains to an individual other than the requestor, a notarized authorization to release the

record may be required from the person who is the subject of the request.

HAND-DELIVER OR MAIL THIS REQUEST TO:

City of Detroit FOIA Coordinator or DPD Law Unit

City of Detroit Law Department

Coleman A. Young Municipal Center

2 Woodward Avenue, Suite 500

Detroit, Michigan 48226-3437

Request For Police Records Template