KALKASKA POLICE DEPARTMENT REQUEST FOR PUBLIC RECORDS by qsl68933

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									                                                     KALKASKA POLICE DEPARTMENT
                                                        REQUEST FOR PUBLIC RECORDS
                                                  MICHIGAN FREEDOM OF INFORMATION ACT
(Print or Type Your Request)

                 TO BE COMPLETED BY REQUESTOR                                                                       METHOD OF ACCESS TO RECORD
NAME OF PERSON MAKING REQUEST
                                                                                                     MAIL TO REQUESTER                          MAIL TO (If Different Than Requester)
COMPANY REPRESENTING                                                                          STREET ADDRESS


STREET ADDRESS                                                                                CITY


CITY                                                                                          STATE                                                 ZIP CODE


STATE                                     ZIP CODE                                            SIGNATURE OF REQUESTOR


PHONE NUMBER                              DATE                                                DATE & TIME


YOUR CLIENT OR INSURED

                                                                                                                      KALKASKA POLICE - USE ONLY
YOUR FILE NUMBER                                                                              OFFICIAL RECEIVING REQUEST


                                                                                              iNCIDENT NUMBER/FILE CLASS                            DATE & TIME RECEIVED

                     TYPE OF REPORT REQUESTED
                                                                                              METHOD OF RECEIPT

       INCIDENT REPORT NUMBER                ____________________



       UD-10 TRAFFIC CRASH ______________________________                                                                           ACTION TAKEN

                                                                                                     DOCUMENT PROVIDED AT THE KALKASKA POLICE DEPT
       PHOTOS __________________________________________
                                                                                                     COPY OF REQUESTED RECORD TO FOIA COORDINATOR


       OTHER ___________________________________________                                             REQUESTED RECORDS UNAVAILABLE AT THE KALKASKA
                                                                                              POLICE DEPARTMENT

                                                                                                     OTHER
CRIMINAL HISTORY RECORD (Michigan Criminal History records are available by
visiting the website at www.michigan.gov/msp and clicking on ICHAT.) The cost for
providing this record is $10.00.                                                              DOCUMENTS RELEASED: ____________________________________
                                                                                              ___________________________________________________________
Traffic Crash Reports are also available at the website www.michigan.gov/msp and              ___________________________________________________________
clicking on TCPS. The cost for providing this record is $10.00.
                                                                                                     COPIES OF RELEASED DOCUMENTS ATTACHED TO THIS FORM
NAME REFERRED TO IN RECORD

                                                                                                             FOIA COORDINATOR RECOMMENDATIONS
SID NUMBER                                FBI NUMBER

                                                                                                     RELEASE                   EXEMPT/DENY (Attach Explanation)
DATE OF BIRTH                             DRIVER LICENSE NUMBER

                                                                                                  __________________________________________________
SOCIAL SECURITY NUMBER* (voluntary)       SEX                                                         SIGNATURE -TITLE                                                     DATE


PRISON NUMBER (If Any)                                                                        ASSESSED FEE’S FOR REQUEST
                                                                                              $
DATE OF EVENT (Month/Day/Year)

                                                                                              MAILING ADDRESS:
LOCATION OF EVENT (Street/City/Zip)

                                                                                                                        KALKASKA POLICE DEPARTMENT
SPECIFIC EVENT TO WHICH RECORD REFERS                                                                                        FOIA COORDINATOR
                                                                                                                              200 HYDE STREET
                                                                                                                             KALKASKA, MI 49646
                                                                                                                                (231) 258-9081
                                                                                                                              Fax (231) 258-5622
                                                                                                                            www.kalkaskapolice.com



                                             * This information is confidential. Disclosure of confidential information is protected by the Federal Privacy Act *



(02/2007)

								
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