Request For Public Records Michigan Freedom Of Information Act
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1RI-101 (10/02)
MICHIGAN STATE POLICE
REQUEST FOR PUBLIC RECORDS
MICHIGAN FREEDOM OF INFORMATION ACT
(Print or Type Your Request)
TO BE COMPLETED BY REQUESTOR
METHOD OF ACCESS TO RECORD
NAME OF PERSON MAKING REQUEST
p
p
MAIL TO REQUESTER
MAIL TO (If Different Than Requester)
COMPANY REPRESENTING
STREET ADDRESS
STREET ADDRESS
CITY
CITY
STATE
ZIP CODE
p
STATE
ZIP CODE
INSPECT COPIES AT:
(MSP LOCATION)_________________________________
PHONE NUMBER
SIGNATURE OF REQUESTOR
YOUR CLIENT OR INSURED
STATE POLICE WORK UNIT USE ONLY
YOUR FILE NUMBER
OFFICIAL RECEIVING REQUEST
WORK UNIT
DATE RECEIVED
TYPE OF REPORT REQUESTED
METHOD OF REQUEST
p
# _______________________
INCIDENT REPORT
p
p
p
p
LETTER
TX
IN PERSON
FROM CJIC
p
CRIMINAL HISTORY RECORD
p
ACTION TAKEN
PHOTOS
p
p
DOCUMENT PROVIDED AT WORK SITE
OTHER
p
COPY OF REQUESTED RECORD TO FOI UNIT
p
REQUESTED RECORDS UNAVAILABLE AT WORK SITE.
REQUEST FORWARDED TO FOI UNIT
p
OTHER
NAME REFERRED TO IN RECORD
SUPERVISING OFFICER’S RECOMMENDATIONS
SID NUMBER
FBI NUMBER
p
p
RELEASE
EXEMPT/DENY (Attach RI-109)
DATE OF BIRTH
DRIVER LICENSE NUMBER
SOCIAL SECURITY NUMBER* (voluntary)
____________________________________________________
SIGNATURE
DATE
PRISON NUMBER (If Any)
DISTRICT/POST/SECTION/UNIT
DATE OF EVENT (Month/Day/Year)
MAILING ADDRESS:
LOCATION OF EVENT (Street/City/Zip)
MICHIGAN DEPARTMENT OF STATE POLICE
SPECIFIC EVENT TO WHICH RECORD REFERS
CRIMINAL JUSTICE INFORMATION CENTER
FREEDOM OF INFORMATION UNIT
7150 HARRIS DRIVE
LANSING, MI 48913
* This information is confidential. Disclosure of confidential information is protected by
AUTHORITY: 1976 PA 442
the Federal Privacy Act.
COMPLIANCE: VOLUNTARY
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