Online Records Request Form

Requester Information
Date of Request*
Date Format: MM slash DD slash YYYY
Time of Request*

: HH

MM
Name*
First Last
Requestor Company / Agency
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Daytime Phone Number*
Email*
Driver's License Number and State Issued*
Record Information Requested
Case or Incident Number*
Date / Time of Incident*
Location of Incident*
Party Involved*
Name Date of Birth
Party Involved*
Name Date of Birth
Records Requested*
Please list other records you are requesting, not listed above.
Acknowledgment and Signature*
- I understand
I affirm this copy of record and/or booking photo shall not be used for the direct solicitation of business for pecuniary gain (C.R.S. 24-72-305.5).