Police Department: Records Division
1781 Zumbehl Road
St. Charles, MO 63303
t: 636.949.3300
f: 636.949.3299
REQUEST FOR COPY OF REPORT
NOTE: Information on this form will assist the St. Charles City Police Department in providing the public
records you are requesting. Some reports may not be available upon request due to ongoing investigation.
Under Missouri law, some information not subject to release may be removed or redacted from records prior
to release.
Date
of Request: _______________________________
Name of Person Making Request: _____________________________________________________________________________
Address: _________________________________________________________________________________________________________
Phone: _____________________________________ Business Phone____________________________________________________
Report Number: ____________________________ Date of Incident: ________________________________________________
Name of Individual Involved in Incident: _____________________________________________________________________
Type of Incident: ________________________________________________________________________________________________
Location of Incident: ____________________________________________________________________________________________
Choose one of the
Following:
_____
I
nvolve
d in incident _____ Insurer of person involved in incident
_____ Attorney of person involved in incident _____ Other, explain: _____________________________________
Reason for request: _____________________________________________________________________________________________
There will be a $10 fee for each report requested. Payments accepted are cash, money order or check made
Payable to the City of St Charles.
Some requests may involve extensive and lengthy searches of police records. State Statute allows for a
reasonable length of time to gather the information. Additional fees may be required. You will be given an
estimate before the request is processed.
Sign
ature/Date: ________________________________________________________________________________________________________
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Office Use Only:
Driver’s License/Other ID__________________________________Check#________________________Receipt#___________
Date Issued______________________ DSN____________________________________________________________________________
click to sign
signature
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