Fillable Printable Police Report Form - Clarkdale

Police Report Form - Clarkdale

REQUEST FOR POLICE REPORT

CLARKDALE POLICE DEPARTMENT

PO BOX 308 / 49 N NINTH ST

CLARKDALE AZ 86324

Voice 928-649-7700, FAX 928-649-7709

Report #___________________________________ Date:____________________________________

Name of person making request (PLEASE PRINT):

First:____________________________________ Last:________________________________________

Address:______________________________________________________________________________

Phone:_____________________________________

Type of Incident: ________________________________________________________________

Name of person involved:_________________________________________________________

Date of Incident:_________________________________________________________________

This is a request to inspect the report.

This is a request to obtain a copy of the report.

Are you a victim of this crime? Yes No

Is this request for law enforcement/government purposes? Yes No

Is this request for non-commercial purposes? For commercial purposes?

Signature:___________________________________________________________________________

FOR OFFICE USE ONLY

Request made via: in person ____________ Date received:________________

mail ____________

e-mail ____________ Date processed:_______________

fax ____________ How report was delivered:

____________________________