The Party of Interest Identified in the Requested Report
Signature: ____________________________________ Date: _______________________________________
ATTENTION: Requestors of crime reports and/or accident reports must have their identity verified in person at the Roseville Police Department Records Section prior to your request being fulfilled. If you have questions about what you are wanting to request, please call the Police Records Section at (916)774-5030.
When your identity is confirmed, you can advise the Records Staff how you would like to receive your report; email, US Mail, pick-up.
Release by: _________________________________________ Redacted By: _____________________Date: _________________________
Comments: __________________________________________________________________________________________________________
Method Relased: _____ Front Counter _____U.S. Mail _____Email _____Faxed
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