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Public Records Request Form
In accordance with State Statute / Code _____________, I am requesting
access to ____copy / copies of the following records:
1. Officer _____________'s training records that pertain to his / her
instruction / certification and continuing education of traffic speed
enforcement and to the use of the speed detection device that was used
to ascertain the speed of the vehicle described in citation
#_______________.
2. Officer _____________________'s daily log for the day of
______________.
3. Officer _____________________'s radar log for the day of
______________.
4. The name, model and serial number of the speed measuring device used
to ascertain the speed of the vehicle described in citation #
_____________ and the serial numbers of the tuning forks used to test
the speed measuring device.
5. Copies of maintenance and / or certification records, for the last
twelve months, of the speed measuring device that was used to ascertain
the speed of the vehicle described in citation # _______________.
6. A copy of the FCC (Federal Communications Commission) license that
authorized the issuing police agency and operator of the speed measuring
device to lawfully operate the device on a specific frequency and / or
range of frequencies.
7. A copy of both sides of the officer's copy of citation #
_________________.
8. Other record(s) needed:
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
The records that I am requesting DO / DO NOT need to be certified or
their authenticity verified. If there is an additional charge for this,
I understand that I must pay for that charge.
I am requesting that the requested records be mailed to me at the
following address:
_______________________________________________
_______________________________________________
_______________________________________________
I will pick up the records upon notification that they are available.
Signed ______________________________________
Date ______________________________________
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