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Request for Public Records

2. Additional Information
   For Additional Information refer to the Michigan Freedom of Information Act Questions/Comments Phone:734/394-5412 Fax: 734/394-5478

   For Additional Information refer to the Michigan Freedom of Information Act Questions/Comments Phone:734/394-5412 Fax: 734/394-5478

4. Criminal History Checks and UD-10 Requests
   Criminal History Records and UD-10 Traffic Crash Reports are unavailable but can be purchase from the below listed sites.

   Criminal History Records and UD-10 Traffic Crash Reports are unavailable but can be purchase from the below listed sites.

6. Criminal History Checks
   ICHAT

   Cost: $10.00

7. UD-10 Traffic Crash Reports
   UD-10 Traffic Crash Reports

   Cost: $13.00

9. Company Representing

   If submitting on behalf of a company

13. Requestor Information
    Information for Person Making Request.

    Information for Person Making Request.

15. First Name*

16. Last Name*

18. Address1*

20. Address2

22. City*

23. State*

24. Zip*

26. Phone Number*

    Phone Number with area code

27. Fax Number

    Full Fax Number

28. Relationship*
    -- Select One --VictimOwnerComplainantSuspectPatientOther

    Relationship to Person Making Request

29. Other

    Explain Other Relationship

31. Incident Number

    Incident Report Number

32. Report Type*
    -- Select One --CriminalAccidentFireEMSEnvironment Site AssessmentOther

    Select appropriate type

33. Other

    Explain Other Report Type Selection

35. Type of Records Requested*

    Describe the type of records that you are looking to receive

39. Requested Name
    Name in Record Being Requested

    Name in Record Being Requested

41. First Name*

42. Last Name*

43. Date of Birth

    Date of Birth of Person in Report

45. Date of Event
    Date of Event

    MM/DD/YY

46. Sex
    -- Select One --MaleFemale

    Sex of Person in Report

47. Event

    Specific Event to Which Record Refers

48. Location of Event

50. City*

51. State*

52. Zip

54. Authority: 1976 PA 442; Compliance Voluntary

    Authority: 1976 PA 442; Compliance Voluntary

Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field