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Whitpain Township Police Department Public Record Review/Duplicate Request Form
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This form has been modified since it was saved. Please review all fields before submitting.
Name of Requestor
*
Street Address
City
State
Zip Code
Phone
*
Email
Date of Request
Date of Request
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
I agree.
Electronic Signature
Review or Duplication
Review
Duplication
Both
I Request review or duplication (check applicable boxes) of the following records.
Records Requested
*
Important: You must identify or describe the records with sufficient specificity to enable the Township to Determine which records are being requested. Use additional sheets if necessary.
For Official Use Only:
The fields below are for official use only. Please do not complete these fields.
Request Number:
Date
Date
Approved
Date
Date
Denied
Date
Date
Request Reviewed By
Comments
Total Number of Reports
Total Number of Photographs
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