2. Date*
   MM/DD/YYYY
3. Request Number
5. Name
   Optional
7. Address1
   Optional
9. Address2
   Optional
11. City
    Optional
12. State
    Optional
13. Zip
    Optional
15. Telephone #
    Optional
16. Email Address
    Optional (Needed if response to the request is requested electronically if possible)
18. Requested Records*
20. If these records are not readily available at the time of your request, please advise whether you desire to:
22. Pick up the records

    1. Pick up the records
24. Or
26. Email

    1. Email
28. Portsmouth Police Department - Access to Public Records Request Receipt
    If you desire to pick up the records, they will be available on _______________ at the front desk. 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 choose to pick up the records but did not include identifying information on this form (name, etc.), please inform the officer/clerk at the front desk of the date you made the request, records requested and request number: _________________ Thank you.
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit Submit and Print

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