Police Records Request
* Name
* Address
* City/State/Zip
* Phone #
Drivers License # / State
Report / Case #
* Report / Case Date
* Type of Incident Accident         Fraud
Theft/Burglary    Other
* Your Involvement
* Reason For Request
* I declare under penalty of perjury that: I am I legally represent

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

Security Measure