excellence • professionalism • community partnerships

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: 
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: