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Cobb County Police Department Incident Report Request
Incident Report Number (ONE REPORT PER FORM) _______________________________________________
Type of Incident _________________________________________________________________________
Date of Incident /If Not Known Give Approximate _______________________________________________
Name of Involved Party Victim/Suspect/Witness/Other ________________________________________
Your Name (please print)________________________________________________________________________
______________________________________________ __________________________________
Signature of Requestor Date and Time
(Home)_________________________(Work)_________________________(Cell)_________________________
Contact Phone Numbers (You will be notified within three (3) business days)
DO NOT WRITE BELOW THIS LINE --- OFFICE PERSONNEL ONLY
After review of the above request, this report:
Confidential Copy - Is open for release with limitations pursuant to OCGA 50-18-72(a)(11.3)(A) &
OCGA 50-18-72(a)(13).
Public Copy - Initial report only pursuant to OCGA 50-18-72(a)(4) and with limitations pursuant to
OCGA 50-18-72(a)(11.3)(A) & OCGA 50-18-72(a)(13).
Other_____________________________________________________________________________________
_____________________________________________ __________________________________
Signature of Records Employee Date
Notification Date _____________________/_________ Attempted _______________________________
Initial Date/Initial Date/Initial Date/Initial
_____________________________________________________________________________________
Transfer to Supervisor or Records Custodian For Review _______________________________
Date
_________________________________________ _______________________________
Signature of Records Custodian or Designee Date
Fees due upon release _______________________