BOUNTIFUL CITY
REQUEST FOR RECORDS

REQUESTER’S NAME: ________________________________________________________________________

REQUESTER’S ADDRESS: ____________________________________________________________________

CITY: ____________________________ STATE: __________________________ Zip: ____________________

DAYTIME TELEPHONE NUMBER: _____________________________________________________________

CASE NUMBER: __________________________DATE OF OCCURRENCE: ____________________________

LOCATION OF OCCURRENCE: ________________________________________________________________

TYPE OF INCIDENT: _________________________________________________________________________

A request for records form must be filled out for each record you wish to obtain.

REASON FOR REQUEST:

_____    Requester has criminal charge currently pending.
_____    Parent or legal guardian of an unemancipated minor who is the victim, subject, suspect or witness in this record.
_____    Legal guardian of a legally incapacitated person who is the subject of the record.
_____    Requester is the person who submitted the record.
_____    Government Agency (See release form).
_____    Insurance Company.
_____    Court order or legislative subpoena.
_____    Other: ______________________________________________________________________________________________
                        _______________________________________________________________________________________________

I understand that the City charges a $5.00 fee for each record requested and that copies will be provided subject to fees being paid.  I also understand that as soon as reasonably possible, but no later than ten (10) business days after signing this Request for Records I will be notified whether my request was approved or disapproved.  I also understand that photo identification will be required before the record is delivered to me.  After a requested report is prepared, it will be held by the Bountiful Police Department for thirty (30) days, after that time that copy will be destroyed.

DATE: _____________ SIGNATURE: ____________________________________________________________

FOR OFFICE USE ONLY

RECEIVED BY: DISPATCHER’S INITIALS ________________ DATE ________________ TIME ____________________

SEARCH INFORMATION:
INITIALS              DATE     COMMENTS                                        INITIALS              DATE     COMMENTS
________             ______    _____________________                       ________            _______  _________________
________             ______    _____________________                        ________           _______  _________________
________             ______    _____________________                        ________           _______  _________________