Online Records Request - CCJRA

I, request the release of:

Please select one of the options below indicating the type of Records you are requesting

Date of Request:
Time of Request:

The following information is needed to identify the correct record:
Incident # (S-):
Case Report #:
Date of Incident:
Time of Incident:
Location of Incident:
Person Involved in Report:
Date of Birth:
Address:
City:
State:
Zip Code:

Requestor's Name:

Requestor's Address:

Address Line 2:

Requestor's City or Town:

Requestor's State or Province:

Requestor's Country:

Requestor's Zip or Postal Code:

Requestor's Phone:

Requestor's Fax (if applicable):

Requestor's Email:

Additional Information: