Requestor Full Name

Email *

Phone

Company

Address

Street Address

City

State

Country

Postal code

For Police Department Requests:

Date of Birth

Report Number

Type/Nature of Incident

Location of Incident

Date of Incident

Records Sought *

Is this request for commercial purposes? *

Yes

(It is a violation of the Freedom of Information Act for a person to knowingly obtain public records for commercial purposes without disclosing that it is for a commercial purpose.)

Are you requesting a fee waiver? *

Yes

If yes, state reason:

I wish to have copies certified at a fee of $1.00 per document. *

Yes

I authorize the police department to email any responsive records to the above email address.

Email response requested.

If you do not select email authorization, the response will be sent via US mail or left for pick-up.

US Mail

Left for Pick-Up

The City of Northlake will respond to the above request within 5 working days from the above date unless one or more of the 7 reasons for an extension of time provided for in section 3(E) of the Act are invoked by the City.

Requestor Signature

Clear