Police Inter Agency Records / Reproduction Request

Town of Chino Valley Police Department
Phone: (928) 636-3600
Email: policerecords@chinoaz.net

I, hereby request: *

Paper Copies Electronic Copies

Pictures Body Cam

Departmental Report (DR) Number (example 15c-00000)

Date of Incident*

All names involved, include Date of Births (DOBs)

Look up by Address

Type of Incident (example Accident, Harassment, Sex Offense, etc.)

Special requests / Additional Information (example Description, Body Cam, Pictures, etc.)

Request Certification

I certify that the public records will be used for: *

Non-commercial purposes

Commercial purposes (*)

(* See below A.R.S. § 39-121.03(D) for definition of “Commercial purposes”.)

If for commercial purposes, describe the manner in which these records will be used:

A.R.S. § 32-101 – I understand that the information requested may include documents that have been sealed by a “technical registrant” (architect, engineer, etc.). I agree to keep and protect the document from further distribution and not to allow further reproduction of the document.

Click below to read:

A.R.S. § 32-101

I declare that I have read A.R.S. § 39-121.01 [Link to Statute below] and/or A.R.S. § 39-121.03 [Link to Statute below] and understand the contents therein.

Click below to read:

A.R.S. § 39-121.01

Click below to read:

A.R.S. § 39-121.03

I further declare under penalty of perjury that the foregoing is correct and true.*

Agency Information

Date of Request*

Agency Name:

Contact Name:*

Phone Number:*

Email Address:*

Attach / Upload Forms, Waiver, etc:

Convert to PDF?
(DOC, DOCX, XLS, XLSX, TXT)

Attach / Upload Forms, Waiver, etc:

Convert to PDF?
(DOC, DOCX, XLS, XLSX, TXT)

Attach / Upload Forms, Waiver, etc:

Convert to PDF?
(DOC, DOCX, XLS, XLSX, TXT)

Log #: