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P:/PD Forms & Labels/Administrative Forms MPD 20.36 Rev 06/19 Records Release Form Case Number Date of Incident Offense Person’s APPLICANT INFORMATION NAME DOB Last First MI ADDRESS PHONE Street City State BUSINESS AGENCY (if applicable) DRIVERS LICENSE NUMBER EMAIL ADDRESS 24-72-305.5 Access to Records-Denial by Custodian-Use of Records to Obtain Information for Solicitation. Records of official actions and criminal justice records and the names, addresses, telephone numbers and other information in such records shall not be used by any person for the purpose of soliciting business for pecuniary gain. The official custodian shall deny any person access to records of official actions and criminal justice records unless such person signs a statement which affirms that such records shall not be used for the direct solicitation of business for pecuniary gain. By signing this form, I acknowledge that I have read and understand the above Colorado Revised State Statute and am not requesting this information for solicitation of business of pecuniary gain. Applicant signature FOR OFFICE USE ONLY DENIAL OF INSPECTION: Reason for Denial ( ) Contrary to State Statute ( ) Prohibited by Rules of Order of Court ( ) Contrary to Public Interest Accident Report Crime Report/Narrative Released by: Other: FEES: Victim = No charge Cost per copy per page (black & white pages only) $5.00 up to 10 pages. $0.25 for each additional page Pages x $.25 = Supervisor Approval: MONUMENT POLICE DEPARTMENT 645 Beacon Lite Road Monument, CO 80132 [PHONE REDACTED] Fax: [PHONE REDACTED] www.townofmonument.org