PIA Request Form
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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, 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