CAMPBELL POLICE DEPARTMENT
70 N First St, Campbell, CA 95008 * (408)866-2121
Fax (408)379-7561 email: recordsunit@campbellca.gov
REPORT COPY REQUEST
PLEASE PRINT – COMPLETE ALL SECTIONS OF THIS REQUEST.
Vague or incomplete answers may cause denial.
1. Your Name _____________________________________________________________
Your Mailing Address ____________________________________________________
Street Number City State Zip
Your telephone number (_____) ______________________
Include area code
2. Select type of report/request :
Accident Crime Photos Other (specify) ___________________
Case or Incident Number ______________________________
3. I certify that I am :
Named in the report An Authorized Representative
Person named in the report ___________________________
Date/Time of Incident or Date Range ________________________________________
Location of Incident ______________________________________________________
Signature ____________________________ Date _________________
I declare under penalty of perjury that the above information is correct.
I understand
that this report may become public record if released to me
Please check one: Mail Pick Up
___________________________________________________________________________________________
For Office Use Only:
Date:
Date:
Date:
Date:
Date:
# of pgs released: _______ or Page nos. released:__________________________________________
