pia_request.pdf
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Centreville Police Department
RECORDS REQUEST FORM
NOTE: Generally, once a case is closed and no longer being investigated, the report and records are available for inspection. Additionally, under Maryland law, we are unable to release juvenile information, unless the juvenile is charged criminally as an adult. All requests will be reviewed and if approved, typically will be forwarded within 7-10 business days. However, if more time is required to fulfill the request, it shall not
exceed a period of 30 days from the initial request for records.
FEES: - $10 per report via email $25 per report via certified mail
- $75 per Body Worn Camera Video Evidence videos that have a total run time of over an hour is
subject to an additional fee of $10 per minute.
Type of record requested: Police Report ☐ Body Worn Camera Footage ☐ Please complete the following contact information:
Name: _________________________________________ Date: _________________________
Address: ___________________________________________________________________________
Phone #: ___________________________ Email: ____________________________________
How would like to receive the records?
US Mail – Address Above Pick up in person, when notified Email Incident Date: _____________________________ Incident Time (Approx.): ________________
Incident/Case #: ______________________________________
Incident Type: _____________________________________________________
Incident Location: ____________________________________________________________________
Investigating Officer: ____________________________________________
FOR INTERNAL USE:
Date Received: ______________________________ Time Received: _____________________
Received via: US Mail (Attach Envelope to request) In Person Email/Electronically Received by: _________________________________________
Records Released: Yes No, provide reason: ____________________________________
Date Released/Sent: ______________________________
Release Approved by: __________________________________________________________________
PIA From 10/29/2024