Fillable Greeley/Weld Criminal Justice Records 1551 N. 17th Avenue

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Greeley/Weld Criminal Justice Records 1551 N. 17th Avenue

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Greeley/Weld Criminal Justice Records
1551 N. 17th Avenue #3
Greeley, CO 80631
(970)350-9627
FAX (970)304-6505/(970)304-6504
Application for Release of Criminal Justice Records
Clearance Letter
If No: ____________________________________________
Other Actions Taken: _______________________________
Amount Due $ _____ Amount Paid $ _____
Was information released? Yes No
Released By: _________ Date: ___________
Person Requesting: ________________________________________________ Date: __________________________
Phone: _________________________ Email Address: ____________________________________________________
Clearance Letter Name (if different from requester): _________________________________ DOB: _______________
AKA, Maiden, or Other Names Used: ___________________________________________________________________
ID Verified Reason: Housing Employment Job Corps Received By: ___________________
_________________________________________________________________________________
Request for Release of Juvenile Information
Parent or Guardian's Signature: ________________________________________
USE OF THIS INFORMATION IS REGULATED BY LAW - DO NOT DISSEMINATE
Note: According to the Colorado Revised Statute 24-72-305.5, records of official action, criminal justice records, or the
names addresses, telephone numbers, and other information in such records shall not be used by any person for the
purpose of directly soliciting business for pecuniary gain. A violation of this section subjects you to misdemeanor
charges and upon conviction, a fine of $100 or 90 days in jail or both.
I affirm that I will not use the records, or any portion of the records requested for the purpose of directly soliciting
business for pecuniary gain.
Signature: _________________________________________________ Date: _______________________
For Official Use Only:
Release Authorized By: _______________________________________ Date: ______________________
Notarized For: Adoption Immigration Visa Other: ___________________________________________
Yes No
I authorize juvenile information to be released. I understand this is not required by law.
GPD 1840B Revised 052717
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GreeleyWeld Criminal Justice Records 1551 N. 17th Avenue

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Completed 7 December 2020

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