Form Center

911 Audio & Data Request

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