PIA Request Form
Document Date unknown · 1 page(s)
Read as text View original PDF ↗
This is the Centreville Police Department Records Request (PIA) form used to request police reports and related records. It notes that closed-case reports are generally available, juvenile information is withheld unless the juvenile is charged as an adult, and requests are reviewed and, if approved, forwarded within 7–10 business days. The form lists fees ($10 per report, $50 per body-worn camera video), asks for requester contact and incident details, and includes an internal-use section to record receipt method, who received it, whether records were released (and why not), and the release date.
Show the raw extracted text
Exactly as extracted, unformatted — for checking against the original. The readable version is easier to read.
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, will be forwarded within 7-10 business days. FEES: - $10 per report - $50 per Body Worn Camera Video 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: ______________________________ PIA From 2.10.2020