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2. Requestor Information
4. Name of Requestor*
5. Relationship*

   Attorney / Insurance Co. / Victim, etc.

   (*If an attorney or insurance co., please list the client's name.)

6. Client's Name
8. Street Address*
9. Suite / Floor / Apartment
11. City*
12. State*
13. Zip Code*
15. Phone*
16. Fax
17. Email*
19. Record(s) Requested
21. Date of Request*
    Date of Request
22. Report number (if known)
24. Information requested: (Please be as specific as possible to assist our staff in properly identifying the information of your request. You may attach additional pages if necessary.)*
    Be clear and concise. Provide as much detail as possible, ideally including subject matter, time frame, and type of record or party names. RTKL requests should seek documents, not ask questions. Requestors are not required to explain why the records are sought or the intended use of the records unless otherwise requested by law.
26. Submit this completed form to the Records Division of the Ross Township Police Department. Please note that there is a $0.25 per page charge for all information provided, with the exception of state crash reports for which a $15 flat fee will be assessed.
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field