CSUSM POLICE DEPARTMENT - DOC by nth14726

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									CALIFORNIA STATE UNIVERSITY
POLICE DEPARTMENT
441 La Moree Road
San Marcos, CA 92096
(760) 750-4567

                              REQUEST FOR A POLICE REPORT
             (Please Note: Requests may take up to ten (10) days to process)


Name: ________________________________                                             Date:        ___________________

Mailing Address: ___________________________________________                       Telephone#: __________________

City: _______________________ State:_____ Zip: _________ Driver’s License/ID#:                  ___________________


Signature: ___________________________________


CASE REPORT NUMBER:                                             DATE/TIME OF
                                                                OCCURRENCE:

NAME OF INVOLVED                                                TYPE OF REPORT:
SUBJECT:
                                                                ( ) CRIME        ( ) INCIDENT      ( ) ACCIDENT


Delivery Method:           Pickup:    ____                       Status:           Picked-up on:      ______________
                              Mail:   ____                                         Mailed on:         ______________
                          Delivery:   ____                                         Delivered on:      ______________

Method of Payment:         Check#:    _________                                    Amount Paid:      $ _____________
(Check or Money Order only accepted – Non Refundable))

Make $5.00 check payable to Cal State San Marcos                                   Date:    _____________________
 (Your cancelled check will serve as your receipt.)

                            CSUSM INTRA-CAMPUS RELEASE OF INFORMATION
Name of Department:

Contact Person:

Telephone Extension:


                                         REPORT REJECTION NOTICE:

We are unable to fulfill your request for a copy of the police report based upon the following:

____       1. Insufficient fee/no fee submitted. The cost for copies of reports, regardless of number of pages, is
              $5.00 to non campus affiliates:     (Make check payable to CSUSM)

____        2. Report includes information that is not subject to release to the general public, pursuant to
              Government Code Section 6254(f).

____        3. We were unable to locate the case with the information you supplied. Case does not exist or wrong
               law enforcement agency.

REALEASE AUTHORIZED (Yes) (No) BY: ______________________________                               DATE: ____________

REV 07-01-29

								
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