CITY OF GLEN DALE POLICE DEPARTMENT, 402 WHEELING AVENUE, GLEN DALE, WV 26038
CRIMINAL AND CRASH REPORT REQUEST FORM
(PURSUANT TO THE WEST VIRGINIA FREEDOM OF INFORMATION ACT 29B-1)
_____ CRIMINAL REPORT _________ CRASH REPORT
REQUESTER INFORMATION:
NAME: _________________________________________ TELEPHONE: (___)_____________________
ADDRESS: ______________________________________ FAX (____) __________________________
CITY: _________________________________________ STATE: __________ ZIP: ______________
ALL INFORMATION REQUESTED BELOW MUST BE PROVIDED FOR REQUEST TO BE PROCESSED
CIRCLE ONE
CRIMINAL REPORT VEHICLE CRASH REPORT
DATE OF CRIME _________ / ________ /________ DATE OF CRASH: ______/ ______ / _______
LOCATION OF INCIDENT / CRASH ____________________________________________________________
VICTIM'S)/DRIVER'S)/OWNER'S): ___________________________________________________________
TYPE OF CRIME: __________________________________________
FEE SCHEDULE
CRIME/CRASH REPORT......... $20.00 X _____ VIDEO/AUDIO TAPES ........ $50.00 X _____
CERTIFY ABOVE COPY ........ $25.00 X _____ SET OF PHOTOS (UP TO 12).. $25.00 x _____
FAX ABOVE COPY (CRASH ONLY) $25.00 X _____ EACH ADD SET OF PHOTOS .. $25.00 X _____
(UP TO 12)
These fees are for reports 50 pages of less in length. An additional copy fee of $1.00 per sheet will apply after 50 pages
TOTAL SUBMITTED: $________________________ DO NOT SEND CASH
MAKE CHECK OR MONEY ORDER PAYABLE TO: THE CITY OF GLEN DALE POLICE DEPARTMENT
Fees are considered search fee and are non-refundable
MAIL TO THE APPROPRIATE ADDRESS LISTED BELOW INCLUDING PAYMENT AND SELF ADDRESSED ENVELOPE
CITY OF GLEN DALE POLICE DEPARTMENT
CRIME/CRASH REPORTING
402 WHEELING AVENUE
GLEN DALE, WEST VIRGINIA 26038
INFORMATION: 304-845-5511
FAX: 304-845-3475
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Your request could not be processed due to the following:
__ No fee/Incorrect fee enclosed (See fee schedule)
__ Check or Money order is incomplete. Please correct and re-submit
__ Incomplete information submitted. Please include highlighted items upon return
__ No Report could be found based upon information provided
__ Incident investigated by another agency. Report must be requested from that agency.
__ No photos available
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Office use only Report# _____________________ Check# __________________ GDPDCCRR1
Revised March 1, 2005
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[City of Glen Dale, WV].