Fillable Police Department POLICE RECORDS REQUEST (Town of Sahuarita)

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Police Department POLICE RECORDS REQUEST (Town of Sahuarita)

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Police Department
POLICE RECORDS REQUEST
Town of Sahuarita | 315 W. Sahuarita Center Way | Sahuarita, AZ 85629 | 520.344.7000 | www.sahuaritaaz.gov
SPD005 SSD070815(REV042517)
Chief of Police John D. Noland
Community * Safety * Service
The information provided on this form will assist the Sahuarita Police Department in providing the
public record(s) you are requesting. Under Arizona Law, some information that is not subject to
release may be removed from records.
Accepted Methods of Payment: Debit/Credit cards, Money Order, Cash (Exact change only.)
Name of Requestor: _________________________________________ Today’s Date: _________________________
Address: ___________________________________________________ City/State/Zip: __________________________
Phone Number: ___________________________ Email: __________________________________________________
Note: An email may be required to supply certain digital data.
How were you involved in the incident(s):
Victim Suspect Witness Other: ____________________________________________
Does the case(s) above involve a juvenile? Yes No Unknown
I certify that I am the Parent or Legal Guardian of one or more of the minor(s) involved.
Child or Children’s name(s):__________________________________________________________________________
Request Purpose:
Commercial Purpose* Legal Media Personal/Non-commercial
*Complete a statement of Commercial Purpose Pricing Computation Worksheet and Statement of Commercial Purpose Below.
A Commercial Purpose Means that the requestor intends to use the records, directly or indirectly, to receive monetary gain, such as by
selling all or parts of the records, or by using the names, addresses, and phone numbers in the records for solicitation.
Statement of Commercial Purpose: _________________________________________________________________________________
_____________________________________________________________________________________________________________________________
You must provide sufficient information to specifically identify records, such as a case number,
incident location and/or date of occurrence. Please use the following lines to describe your request.
______________________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Digital Copy:
Some cases may not be available on the date of request due to further investigation, authorization for
release or significant redaction. If your case is delayed for any of the reasons listed, Sahuarita Police
Records may provide you with a digital copy sent to your personal email account at no charge.
If you wish to receive a digital copy of your police report, please provide your email address on the other
side of this form. If for any reason the digital report cannot be transmitted, we will contact you by
phone.
NOTICE:
Emailed reports will be redacted at the highest level regardless of the requestor's involvement. This is
to protect any and all juvenile or personal information from being exposed to infected, intercepted, or
corrupted email. The email recipient, should check for threats with proper software prior to opening
any attachments sent from the spdrecords@sahuaritaaz.gov email account. The Sahuarita Police
Department does not accept liability for any damage inflicted by viewing the content of the requested
email/report. Unredacted or minimally redacted reports are only available in person or via a U.S. mail
request. A .25 cent per page fee is placed on requests made in person and by mail. Victims may
receive one free paper copy of their report.
OFFICIAL USE ONLY
Processed by (Name & Badge): ______________________________________________________________________
Released Authorized By (If Applicable): _______________________________________________________________
----------------------------------------------------------------------------------------------------------
Information Released: _______________________________________________________________________________
How was the information released: __________________________________________________________________
Date of Release: __________________________
Method of Payment: Cash Credit/Debit Money Order
Receipt #: __________________________________ Cost: $_________________________________
----------------------------------------------------------------------------------------------------------
Information Released: ________________________________________________________________________________
How was the information released: ___________________________________________________________________
Date of Release: __________________________
Method of Payment: Cash Credit/Debit Money Order
Receipt #: __________________________________ Cost: $________________________________
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Police Department POLICE RECORDS REQUEST (Town of Sahuarita)

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Completed 16 July 2020

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