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4. Requester Information
6. I am the:*
   -- Select One --VictimSuspectDistrict AttorneyFBIDTFEPDInsurance CompanyOther

   Please select your relationship to the requested records. (ex. victim, insurance agency, etc.)

8. If you selected other, please explain your relationship to this case.
10. Please provide your contact information:
12. Requester First Name
13. Requester Last Name
15. Mailing Address*
17. Mailing Address 2
19. City
20. State
21. Zip*
23. Phone Number*
25. Email:
27. Please check how you would like to receive this report:

    1. Email
    2. U.S. Postal Service
    3. Pick Up In Person
31. Records Request
33. I am requesting:*

    Select all that apply. 

    1. Copy of a case
    2. Copy of photos of a case
    3. Booking photo
    4. Booking information
    5. Autopsy report
    6. Toxicology report
    7. Other
35. If you selected other, please describe the records you are requesting.
37. Case Number:

    If known, please provide. Otherwise, leave blank and complete the questions below.

38. SA Number:

    If known, please provide. Otherwise, leave blank and complete the questions below.

40. If you do not have a Case Number or SA Number, please provide the following information:
42. First Name of Involved Person
43. Last Name of Involved Person
45. Involved Person's Date of Birth
47. The above stated involved person is the:
    -- Select One --VictimSuspectOther
49. If you selected other, please explain.
51. Date of Occurrence:
52. Location of Occurrence:
54. Additional Information:
58. Notice of Fees*

    Please be advised that there may be a fee associated with the production of records. Fees must be paid upon receipt of records, in person or via mail, cash or check only. 

    The following reports and associated fees are available to release to crime victims, a victim's authorized representative, and/or an insurance carrier:

    • Arson - $11
    • Assault - $11
    • Burglary - $11
    • Carjacking - $11
    • Domestic Violence - Free
    • Explosion - $11
    • Fire - $11 
    • Larceny (Theft) - $11 
    • Robbery - $11 
    • Vandalism - $11
    • Vehicle Theft - $11 

    The following reports and associated fees are available to release to all members of the public upon request:

    • Autopsy - $15
    • Toxicology - $15

    1. I understand that there may be fees associated with my request and agree to pay all applicable fees at time of receipt.
60. Acknowledgement*

    1. I hereby certify that the above statements are true and correct to the best of my knowledge.
62. E-Signature*

    Please type your first and last name. 

63. Date*
    Date
Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit Submit and Print

* indicates a required field