2. Today's Date*

   MM/DD/YYYY

3. Request Number (for internal use)
5. Name
   Optional
7. Address1
   Optional
9. Address2
   Optional
11. City
    Optional
12. State
    Optional
13. Zip
    Optional
15. Phone #

    Optional

16. Email Address

    Optional (needed if no phone number is provided)

18. Requested Records*
20. Portsmouth Police Department - Access to Public Records Request Receipt

    If, after review of your request, the Department determines that the requested records are exempt from disclosure for a reason set forth in Rhode Island General Laws Section 38-2-2(4)(i.)(A) through (W), the Portsmouth Police Department reserves its right to claim such exemption. Note: If you pick up the records, but did not include identifying information on this form (name, etc.), please inform the Records Clerk at the front desk of the date you made the request and records requested.

    Thank you.

Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit Submit and Print

* indicates a required field