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MONUMENT POLICE DEPARTMENT 645 Beacon Lite Road Monument, CO 80132 [PHONE REDACTED] Fax: [PHONE REDACTED] townofmonument.org Record Release Form Party Requesting Information Name: Date of Birth: Address: Telephone Number: I.D. Provided: (Attach Copy) Driver’s License No.: State: Email Address: Requested Record Crime Report Accident Report Other: Record Requested Defendant’s Full Name: Date of Birth.: Case No.: Offense: Date of the Incident: Pursuant to C.R.S. 24-72-305.5 Access to Records-Denial by custodian-Use 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 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. Signature Date FEES: Cost per copy per page (black & white pages only) $5.00 up to 10 pages, $.25 for each additional page. ____pages x Victim No Charge FOR OFFICE USE ONLY: Paid $5.00 Victim = No Charge Records released by: Date Records Denied: Reason for Denial: Contrary to State Statute Prohibited by Rules of Order of Court Contrary to Public Interest Supervisor Approval: Date: