REQUEST FOR PUBLIC RECORDS

(Covered Under I.C. 5-14-3-5

Policy Statement

It is the policy of the Hendricks County Sheriff’s Office to provide any and all public information permitted under the law to all citizens. In order to better effectively and sufficiently serve you, please complete the information below.

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I hereby request to view and/or copy the information permitted by law of the following:

Section A. Case Report, Accident Report or Sex Offender Registry.

Any record or records pertaining to:_________________________________________________

(List name, type of incident, crime and/or Case or Crash Number)

Date:______________Time:________Location:_______________________________________

AM/PM

Section B. Jail Booking Record.

Information concerning any charges, circumstances of arrest or issuance of a summons, time of arrest, name of arresting officer and agency. Information concerning date and time person was lodged in the Hendricks County Jail and/or date and time person was discharged and amount of bail or bond, if available.

Person Arrested:___________________________________________DOB:________________

(Full Name: Last, First, Middle Initial, any Alias or Maiden Name) (Date of Birth)

SS#:____________________________ADDRESS:____________________________________

(Social Security Number) (Home or Work: House Number, Street, City, at time of Arrest)

Section C. “Calls For Service” Record.

Information concerning the time, substance and location of all complaints and/or requests for assistance received by the Hendricks

County Sheriff’s Dispatch Center on_____________between the hours of_________and__________concerning the following incident

and location:____________________________________________________________________________.

Section D. Investigative Records (Written, Photographic, or Recorded).

Any investigative record of the Hendricks County Sheriff’s Office concerning any investigation which is no longer active and is not prohibited by law from release.

Specific Type of Record Requested:_________________________________________________.

Section E. Sheriff’s Office/Personnel.

Any record or records pertaining to:_________________________________________________

(List Last Name, First Name, Middle Initial, Rank or Title AND/OR Event Type)

Date:______________Time:________Location:_______________________________________

AM/PM

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Name of Person or Persons and/or Business requesting Record Information:

Full Name:______________________________________Agency:______________________

(First, Middle, Last Name / Title) (Business/ Organization)

Address:______________________________City:__________________State:____Zip:_____

HOME phone:(____)_______________________WORK phone:(____)________________

CELL phone:(____)_________________________OTHER:___________________________

2004~PMD/ceh