POLICE DEPARTMENT RECORD REQUEST DENVER
Denver Police Department IDENTIFICATION SECTION
Record Request Form
DENVER POLICE DEPARTMENT RECORD REQUEST
SOLICITUD PARA SOLICITAR UN REGISTRO DEL DEPARTAMENTO DE POLIC?A DE DENVER
Print and mail this form, along with a check or money order made payable to MANAGER OF FINANCE, to the address below / Imprima y mande por correo esta forma, junto con un cheque o un giro postal pagadero a MANAGER OF FINANCE a la siguiente direcci?n:
Denver Police Department / Departamento de Polic?a de Denver Identification Section / Departamento de identificaci?n 1331 Cherokee Street, Room 416 Denver, CO 80204-2787
Include a self-addressed stamped envelope to receive the report. Incluya un sobre con un timbre postal y su direcci?n impresa para recibir el reporte.
Arrest Record / Registro del arrestado Arrest Photo / Foto del arrestado Record Query ? Letter of Police Clearance (Notarized) / Consulta de registro de carta notariada
$ 15.00 $ 9.00 $ 25.00
*A Record Query ? Letter of Police Clearance must be requested in person *Una Consulta de Registro ? Una carta de acreditaci?n polic?a debe ser solicitada en persona.
Include the following information to process your request. Please type or print clearly. Incluya un sobre con un timbre postal y su direcci?n impresa para recibir el reporte. Por favor escriba o imprima claramente
NAME OF PERSON ON RECORD OR PHOTO / NOMBRE DE LA PERSONA EN REGISTRO O EN FOTO
Last Name / Apellido paterno
First Name / Primer nombre
Middle / Segundo nombre
Date of Birth Fecha de nacimiento
Sex / Sexo
Race / Raza
Other Names Used by Person on Record or Photo / Otros nombres utilizados por la persona en el registro o foto
Denver Police Record Number (if known) / N?mero de registro de la Polic?a de Denver (si lo sabe)
PERSON MAKING THE REQUEST / PERSONA QUE HACE LA SOLICITUD
Last Name / Apellido paterno
First Name / Primer nombre
Phone / Tel?fono
Street Address / Direcci?n
City / Ciudad
State / Estado
Zip Code / C?digo postal
TOTAL ENCLOSED / TOTAL INCLUIDO: $
The undersigned affirms that any booking photograph obtained from the Department of Public Safety, Denver Police Department, Denver Sheriff Department or Office of the District Attorney will not be placed in a publication or posted to a website that requires the payment of a fee or other exchange for pecuniary gain in order to remove or delete the booking photograph from the publication or website.
El que suscribe afirma que cualquier foto de la c?rcel obtenida del Departamento de seguridad p?blica, Departamento de Polic?a de Denver, Departamento de Sheriffs de Denver o de la oficina de la Fiscal?a no ser? colocada en una publicaci?n o un sitio web que requiera el pago de una cuota u otro intercambio, para obtener ganancias pecuniarias con el fin de eliminar o borrar la fotograf?a de la carcel de la publicaci?n o el sitio web.
Signature of Requestor / Firma del solicitante
DPD 241A (08/18)
Date / Fecha
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