Right To Know Request Form - Borough Of Emmaus printable pdf download

Right To Know Request Form - Borough Of Emmaus

Right to Know Law Request Form

To:

Office of the Chief of Police

Borough of Emmaus Police Department

400 Jubilee St.

Emmaus, PA 18049

I am requesting access to records of the Emmaus Police Department. I am aware that I will be required to

pay $10.00 per incident report information received and $15.00 per accident report information received.

I have completed the following information:

Name of Requester___________________________________________________

(Please print) First , M.I., Last

Request Date: ______________________________

Mailing Address: ___________________________________________________

___________________________________________________

Telephone Number: _______________________________

Please identify each of the documents that you are requesting. Your request should identify the

documents with sufficient specificity so that department personnel can determine whether these

documents are in our possession and how to locate them. To assist in this process, please fill in the

following information if known:

INCIDENT DATE:___________________________________________________________________

INCIDENT TYPE:___________________________________________________________________

INCIDENT LOCATION:______________________________________________________________

PERSON ARRESTED:________________________________________________________________

I am aware that my signature is required to obtain the requested information. I acknowledge that

by signing this document I am subject to the provisions of PA Crimes Code sections: 4903 (False

Swearing), 4904 (Unsworn falsification to authorities) and other related sections.

___________________________________________________________

(

Signature)

For Office Use Only

Date Received:

Status:

____Access granted

____Denied

____Review

Right To Know Request Form - Borough Of Emmaus