COVINA POLICE DEPARTMENT
Report
#
APPLICATION
FOR RELEASE OF INFORMATION
Name
of
applicant:
Agency:
(PLEASE
PRINT)
Home
address: Home telephone:
Work
address:
Work
telephone:
Requested
Information:
Date/Time
of
incident:
Location:
Report Type: (Please check one)
Arrest Report
Traffic
Collision *Current arrest info/Booking sheet
Crime Report DV Report Incident Report/Call for Service
Other Photos
Party of Interest:
(Please check
one)
Victim named
in
document(s)
requested
Driver, passenger, or pedestrian involved in
traffic collision report requested.
Arrestee
Witness
Reporting party
Insurance company representing subject of
record (claim
#
)
Parent/guardian
of juvenile
Attorney
for:
(authorization
required)
Law Enforcement Officer conducting criminal investigation
Case
No.
Property
owner
Authorized individual
(signed
authorization
required)
Other party of
interest.
(specify)
I declare under the penalty of perjury that I am the party of interest identified above. I am NOT a suspect in this case.
*If I am seeking arrest information, I declare that I am a licensed private investigator or will use the information for scholarly,
journalistic,
political or
governmental purposes
ONLY, per
Government
Code
6254(f)(3).
The
information
SHALL NOT be
used directly or indirectly to sell a product or service to anyone.
Signature
Date:
Booking Sheet and/or Dispo
Investigations/Traffic Review:
(OFFICE USE
ONLY)
Complete Report Released. Processed
By:
Redacted
Copy Released. -
Redacted:
Arrest
Summary ( to )
Comments:
Denied
I
D
Type:
ID
Number:
Released
By:
Date:
Amount:
$
Receipt
#,
