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2. Case Number
   If Applicable
3. Date
   Date Start Date

   —

   Date End Date
5. Victim Name
6. Date of Birth
   Date of Birth
8. Complainant’s Name
10. Incident Address
    No P.O. Boxes
12. City
13. State
14. Zip
16. Identify the Records You Seek*
    Accident Report, Call for Service, Etc. To allow us to expedite your request, please be as specific as possible when describing the records you are seeking (time, date, names of individuals involved). If you cannot identify a specific record, you should clearly explain the type of records you are seeking from what time-frame and what subject matter the records should contain.
18. The requesting person is liable for any further dissemination of information contained in the report.
20. First Name*
21. Last Name
23. Phone*
24. Email Address
26. Mailing Address
28. Address2
30. City
31. State
32. Zip
34. Processing Fees Breakdown
    • Report (FOAA) 1-7 pages: $12 (each additional page after 7: $1)
    • Routine accident reports: $12
    • Color photos on printed paper: $2 each
    • Nonpaper requests (VHS,DVD,CD, Audiotapes): $25 each media form
36. Payment must received before a report can be released, unless other satisfactory arrangements have been made with the records clerk.
    • Processing Time: 7-10 Business Days
    • Payments:
      Cash
      Checks - Made to the Cumberland County Sheriff’s Office
    • Payment Due at Time of Pick-Up or Prior to Mailing
    • Available Pick-up Times: Monday - Friday: 8 a.m. - 4 p.m
    • Closed All Major Holidays
38. Please Note
    Some reports may not be available at the time of this request.
40. Office Use Only
42. Paid

    1. Yes
    2. No
43. Receipt Number
44. Payment Method
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit Submit and Print

* indicates a required field