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Case Record Request Form
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This form has been modified since it was saved. Please review all fields before submitting.
Requestor Information
Requestor Name - Last, First, Middle
*
Phone Number
*
Requestor's Address - Street, City, State, Zip Code
*
Requestor's Email Address
Please insert as much information as possible. Failure to include as much identifying information will delay our ability to complete requests.
Case No.
Date of Birth
Driver's License Number
Defendant - Last, First, Middle
Defendant Address - Street, City, State, Zip Code
Documents Requested:
Defendant's Criminal History
Complaint/Citation
Conviction Documents (i.e. Judgment and Sentence, Plea Form)
Docket
Other documents - please be specific
Do you need the document you are requesting to be certified?
Please be advised that there is a cost of $5.00 for the first page and $1.00 for each additional page.
Yes
No
Request a copy of a recording of a court proceeding:
Compact Disk (CD) FTR Gold format can only be played on a computer with at least Windows XP operating system (or newer) and the FTR Play er ( http://www.fortherecord.com/products/player/ ). Cost is $20.00 per CD.
Date of Court Proceeding
Time of Court Proceeding
Case No.
Signature
Request Date
NOTICE
You will be notified when your records are ready. If there is a cost associated with your request, you must remit payment within 96 hours (excluding weekends and holidays) of the notification that your records are ready.
To be Completed by Court Personnel
Completed by:
Date Completed
Cost
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