Public Information Request

Case Number:
Incident Address:
Incident Date/Time:
Persons Involved:
*Are you Requesting a copy of the Police Report? Yes No
*Documents Requested and Description of Incident
Also, please provide date, time and location of the incident, as well as any other information,
including names of persons involved:
(Please include as much detailed information as possible, as this will help us better serve you.)
Depending on the type of information you request, the cost for this item may exceed the
standard charge or may require a deposit.
WAIVER: Do you give permission to redact (remove) any information that is confidential pursuant to the Attorney General's Public Information Act, Sections: 522.101: Judicial Decisions: 552.102: Employees' personal privacy; 522.117: employee address, telephone nos., Social Security Nos, personal family information; 522.1175: personal information of security officers; 522.130(a); Driver's License , Permit, Title, Registration, Personal ID; 522.137: email addresses when communicating electronically with governmental body.
*Please select one:
*Requestor Signature:
If you need any further assistance, please contact the
Open Records Department at: 
Dayana Chavez - 281-420-6608
Kristen Mills - 281-420-6673
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