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2. First Name (Optional)
3. Last Name (Optional)
5. Phone Number (Optional)
7. E-mail Address (Optional)
9. How do you wish to be contacted?*

   1. E-mail
   2. Phone
   3. I will check back periodically (no phone number or e-mail provided)

   We may contact you in the event that we need more information pertaining to your request. We will also contact you when your records are ready for retrieval. It is not required to provide contact information! Feel free to check back with the Public Records & Support Services Specialist if you do not wish to leave contact information.
11. Type of Record Requested*
    Please explain in detail what record(s) you are requesting. Include a case report/crash report number if applicable.
13. File Upload (Crash Reports Only)
    Please upload your completed Traffic Crash Affidavit and a copy of your driver's license (only if requesting a crash report within 60 days of occurrence). Please note - you may also visit www.buycrash.com to obtain a copy of your crash report.
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15. 1. Receive an email copy of this form.
16. Email address

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