P:\RECORDS\Forms Ordering\Request for Release of Info or Property form.docx (rev. 01/16)
ANTIOCH POLICE DEPARTMENT
300 L Street, Antioch, CA 94509
(925)779-6900
Name: Primary Phone: ( )
Address: Secondary Phone: ( )
City/State/ZIP: Pick up Mail
I understand that the filing of this request does not in any manner obligate the Chief of Police or any employee of the Antioch Police Department to produce such
information, nor does it imply in any manner that such information must or will be furnished. The Antioch Police Department releases information in accordance
with the California Public Records Act.
Signature: Date:
POLICE REPORT COPY REQUEST
Crime Traffic Event Calls for Service
(Location & Date Range Required)
Date/Date Range:
Type of Report:
Report Number(s):
Location:
Involved Parties:
Your Involvement:
Circle one: Victim, Driver, Pedestrian, Passenger, or Property/Vehicle Owner
Involving Juvenile (Request for Release of Juvenile Information form is required.)
Insurance Company representing an Involved Party (List insured name on Involved Parties line above)
Attorney representing an Involved Party (Client Authorization required. Please attach.)
Other (specify):
PROPERTY RELEASE REQUEST
Property Held For: Evidence Safekeeping Found Property
Report Number(s):
Description:
Brand: Make/Model: Color:
POLICE DEPARTMENT USE ONLY
Application taken by: Date:
Amount:
$
Receipt No.:
REQUEST FOR RELEASE OF
INFORMATION OR PROPERTY
click to sign
signature
click to edit
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