SALT RIVER PIMA-MARICOPA INDIAN
COMMUNITY POLICE DEPARTMENT
10,005 East Osborn, Scottsdale, AZ 85256
Phone: (480) 362-6370 Fax: (480) 362-5920
POLICE REPORT REQUEST FORM
Your Name: _________________________________ Phone Number: _____________________________
Address: __________________________________________________ State:________________________
City: _____________________________________ Zip: __________________________
**I hereby certify under penalty of perjury that the requested records will not be used for commercial purposes
as that term is defined under A.R.S. Section 39.121.03. See also Salt River Code of Ordinances Section 6-44.
Your Signature: Date:
The following information is required before a records search will be conducted for your information. Please
1. Name of Person on Record: _________________________________________________________
2. Description of Information Requested: _________________________________________________
SRPD Report# (if known): Date of Incident: ___________ Time of Incident: ________
If report # is unknown please provide incident type: _____________________________________________________
Copy of DVD………………..$10.00 Photographs (CD only)…….$5.00
Explain reason for information requested (Specific detail):
Fee: $5 for each record of 25 pages or less; over 25 pages, an additional $0.15 per page
Cash or checks accepted; NO credit cards.
Make Check Payable to: Salt River Police Department
Mail Request to: Salt River Police Department
10,005 East Osborn Scottsdale, AZ 85256
-FOR DEPARTMENT USE ONLY-
Your request was DENIED based on the following reasons:
Report is held by the Maricopa County Attorney’s Office.
Report is held by the Salt River Tribal Prosecutor’s Office.
Report is pending on-going criminal investigation.
Privacy or confidentiality rights of individuals named within (Juveniles).
SRPMIC Policy 1-8 Information & Confidentiality (SR-CIR-2)
Date Received: ________
Processed by: _________
& Initial: ____________