Police Department PIA Request Form
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This is the Centreville Police Department Records Request Form for public requests of police reports or body‑worn camera footage. It states fees ($10 per report, $50 per body‑worn camera video), notes juvenile information will not be released unless the juvenile is charged as an adult, and says approved requests will be forwarded within 7–10 business days; it also notes reports are generally available once a case is closed. The form collects requester contact information, incident details, preferred delivery method, and includes internal‑use fields to record receipt, how it was received, who received it, whether records were released and the release date.
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Centreville Police Department RECORDS REQUEST FORM NOTE: Generally, once a case isclosedand no longerbeing 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, will be forwarded within 7-10 business days. FEES: - $10 per report - $50 per Body Worn CameraVideo Type of record requested: Police Report ☐ Body Worn CameraFootage ☐ 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: ______________________________