Police – Records Photo Video Request

PIERCETON POLICE DEPARTMENT
207 N. FIRST STREET
PIERCETON, IN 46562
574.594.2232

Instructions: Please complete all sections of this form prior to submission. The information you list on this form will be kept confidential. If there are any changes to the information you provide, after submission, please contact the Pierceton Police Department at 574.594.2232 or police@pierceton.org

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Date *

Date of incident

Report Number: *

Your Name *

First

Last

Citizen’s Name

Phone

Email *

Accident or Incident Request Type: *

• Accident or Incident Report
• Colored Photos
• In-Car Video *
• Body Worn Video *

* More information will be needed to process this request. We will reach out to you to obtain what is necessary.

Report Fees:

$15 – Accident/Incident report
$55 – Colored Photos (Per Report)
$150 – In-car or Body worn video (Per Recording)

Any additional information:

Submit