CITY OF PHILADELPHIA - DEPARTMENT OF RECORDS
APPLICATION FOR
SEARCH AND/OR EXTRACT OF POLICE INCIDENT OR OFFENSE REPORT 		DATE OF APPLICATION (PLEASE ALLOW 2 TO 3 WEEKS FROM DATE OF INCIDENT)
NAME OF APPLICANT

 

 		TELEPHONE NUMBER OF APPLICANT

 
ADDRESS                                                      CITY                                    STATE           ZIP CODE

 

 		DATE OF INCIDENT

 
LOCATION OF INCIDENT

 

DATE INCIDENT REPORTED TO POLICE

 
PERSON(S) INVOLVED

 

 		YOUR CLAIM, POLICY OR FILE NUMBER (OPTIONAL)

 
PERSON(S) INVOLVED

 

 		INCIDENT INVESTIGATION DIVISION NUMBER

 
DISTRICT CONTROL NUMBER

 

 		PHILADELPHIA CODE

 

 		 
COPIES OF FEE NO. APPLICANT'S FEE
  25.00 EACH   25.00 
        $
      $
FEE NOT REFUNDABLE MAIL THIS PORTION WITH APPROPRIATE FEE TOTAL
25.00
PLEASE SEND 2 SELF-ADDRESSED, STAMPED ENVELOPES.

IF YOU HAVE A DISABILITY AND REQUIRE AN ACCOMMODATION IN ORDER TO COMPLETE THIS FORM AND/OR TO PARTICIPATE IN A PROGRAM OR SERVICE, CONTACT THE ADA COORDINATOR AT 686-2266.

82-23 (rev. 8/97)

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CITY OF PHILADELPHIA - DEPARTMENT OF RECORDS

FACT SHEET ABOUT REQUESTS FOR INCIDENT REPORTS

 

PLEASE RETAIN THE BOTTOM PORTION OF FORM FOR YOUR FILES. NOTE THE DATE THAT YOU MAILED YOUR REQUESTS, DISTRICT CONTROL NUMBER, PHILADELPHIA CODE AND ANY OTHER INFORMATION THAT MAY BE PERTINENT TO YOU.

 

DISTRICT CONTROL NO./PHILA. CODE

NAME(S) OF DRIVERS/FILE NO.

DATE MAILED
 
________________________ ________________________________ _________________

 

It is essential that the information provided on this application is accurate.  Information should contain the following: Date of incident, name of driver(s), location of incident, district control number and the Philadelphia Code.  The district control number and the Philadelphia code can be obtained by calling the police district where the incident occurred.   Insufficient or vague information may result in a negative response.

All Inquiries are made and mail is sent to:

Department of Records

Incident Reports

Room 167, City Hall

Philadelphia, PA 19107

(215) 686-2266

 

TO EXPEDITE SERVICE, PLEASE SEND 2 SELF-ADDRESSED, STAMPED ENVELOPES.

MAKE CHECKS OR MONEY ORDERS PAYABLE TO "CITY OF PHILADELPHIA"


FEE NOT REFUNDABLE

PLEASE ALLOW 2 TO 3 WEEKS FROM DATE OF INCIDENT BEFORE APPLYING FOR COPIES.

 

THANK YOU FOR APPLYING BY MAIL