911 Record Request Form

Requestor Information

Requestor Name*

Title / Rank*

Agency*

Official Government Email*

Office Phone Number*

Incident Information

Incident / Case Number*

Date of Incident*

Approximate Time of Call or Estimated Time Range(optional)

Caller Telephone Number if known(optional)

Incident Address or Location*

Additional Information

Please provide any additional details that may assist us in locating the requested recording.(optional)

Certification & Signature

I certify that I am requesting this recording in my official capacity on behalf of my agency for a legitimate law enforcement or governmental purpose.*

Electronic Signature*

Typing your name constitutes your electronic signature.

Signature Timestamp

Auto-generated on signature

Retention Notice: Recordings are retained for one (1) calendar year. Requests older than one year generally cannot be fulfilled.

* Required fields