OAKLAND POLICE DEPARTMENT
Public Records Request Form
TF-3281 (Aug 12)
Use a separate form for each request.
REQUESTOR: PLEASE COMPLETE PART 1 & 2
PART 1 – REQUESTOR INFORMATION
Request Received By
Enter Serial No.
Date of Receipt, if different
Name of Requestor - Last/First Name Email Address
Date of Request
Contact Number
Agency/Company
Alternate Contact Number
Address Oakland/City Zip Code
PART 2 – DOCUMENT / INFORMATION REQUESTED (Requestor to check all boxes that apply and enter all known information)
INFORMATION TYPE
Offense Report Recording: Video Audio In-Car Video CAD Purge
Crime Traffic Accident Traffic Enforcement Incident Training Record
Department Publication Complaint Employment Contract (MOU) Other: ________________________
KNOWN INFORMATION
Report / Citation Number (if known)
Date of Report/Incident
Time of Incident
a.m.
p.m.
Location of Incident
Name of Involved Party
Vehicle Information
License No.
VIN Number
Make
Model
Describe request. (Be as specific as possible)
PART 3 - FOR RECORDS DIVISION USE ONLY
Request Received Via Custodian of Record Assigned PRRC Log Number Response Due Date
Drop-off Mail Other: __________
Enter Organizational Unit
Enter 10 Days
From Date of
Request/Receipt
PART 4 – CUSTODIAN OF RECORD USE ONLY
Release Approved By Notification of Determination Anticipated Completion Date Actual Date Completed
Approved
Denied
Enter Serial No.
PRRC
Requestor
Date
Enter a Reasonable Timeline
Extension Needed – Reason Extension Approved By
New Anticipated
Completion Date
Actual Date Completed
Outside Facility Volume of Search
Consultation Needed Programming Required
Enter Serial No.
Enter a Reasonable Timeline
PART 5 –FEE DETERMINATION AND COLLECTION – Complete if fees are to be collected by the Records Division
Copy Fee: Number of Copies: ______ X $.05/page = $
Authorized Flat Rate Fee: = $
Research Time Fee (Subpoenas Only): Number of Hours: ______ @ $24.00/hour = $
TOTAL COST $
Date Requestor Notified Enter Date Notified Picked up Mailed Other (Describe): _____________
Destruction Date
Enter Date Requested File Destroyed
Signature of Person Picking up Request or
Name of Person Mailing or Other
X
Date
White Copy to Records Division Yellow Copy to Custodian of Record Pink Copy to Requestor
