Request for Police Document (PDF)

REQUEST  FOR  POLICE  DOCUMENT 
 
Under the provisions of Connecticut General Statute 1-210 the Waterford Police Department 
may be unable to provide information immediately upon request.  A reasonable amount of time will 
be needed to review and complete a request.  Please be advised that your request does not guarantee 
the release of information to you.  Many factors determine whether or not any part of a case can be 
released.  Pending cases must be approved by the State’s Attorney’s Office prior to release. 
 
Please circle preferred method of receiving documentation:  
 
E-Mail 
Regular Mail 
Pick-up at Police Department 
 
Instructions:  Using the space below, please provide as much detail as possible.  Print clearly. 
 
 
Date and Time of Request  ______________________ 
Case Number ___________________ 
 
        month / day / year/time 
 
Person Making Request  ____________________________________________________________ 
 
First Name / Middle Initial / Last Name  
 
 
______________________ 
________________________ 
___________________________ 
 
Date of Birth 
E-Mail Address 
Telephone Number 
 
________________________________________________________________________________ 
Street / City / State / Zip Code 
 
 
Signature of Person Making Request  _______________________________________________________ 
 
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Case Number  __________________________ 
Date Needed  ___________________________ 
 
Name and Date of Birth of Person(s) Involved  (If you do not know the date of birth, please estimate.) 
_______________________________________________________________________________________ 
_______________________________________________________________________________________ 
 
Date of Incident (If you do not know the exact date, please estimate.)  
_______________________________________________________________________________________ 
 
Type of Incident (Example:  motor vehicle accident, arrest, burglary, etc.)   
_______________________________________________________________________________________ 
 
Type of Information or Documentation Requested   
_______________________________________________________________________________________ 
Should you need to fax the completed document back to us, our fax number is (860) 443-3953. 
For any fees incurred prepayment is required.  (Exact change or personal check).