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2. Full Name*
3. Title*
5. Agency*
6. Phone*
8. Nature of Request*

   1. Audio playback review
   2. Audio CD/DVD
   3. CAD CFS Detail Report

   1. Phone Communications
   2. Radio Transmissions - Police
   3. Radio Transmissions - Fire
10. Time Stamps on Recording?*

    1. Yes
    2. No
12. Incident Date*
    Incident Date
13. Incident Time
    Incident Time
15. Person(s) Involved
17. Location/Address*
19. City*
20. State*
21. Zip*
23. Case/Incident #
25. Nature of Incident*
27. Reason for Request*
29. How would you like the information disseminated to you?*
    -- Select One --In person/pick upEmailed/secured weblinkMailed
30. Date Needed By*
    Date Needed By
    Date of Court/Hearing, Review, etc.
32. What email address should we send the information to?
34. Address to send the information too
36. City
37. State
38. Zip
40. I certify that the information from this tape will be utilized in conducting Official Business of my Agency, and for the sole and express purpose(s) outlined above. I fully understand that any other use or disclosure may expose my agency and me to legal and criminal liability.
42. Electronic Signature*
44. Call received via:

    1. 911 - Phone
    2. 911 - Radio

    1. CCSO
    2. MSP

    1. Other
46. Disposition of Request:
48. Emergency Communications Representative providing records
49. Date
    Date
51. Dissemination of Request

    1. In Person

    1. Mailed

    1. Emailed/Online
53. Signature of Person Picking Up/Accepting Request
54. Date
    Date
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field