Privacy Act Request Instruction
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Provide your complete name and mailing address.(Telephone, fax, and e-mail addresses are optional.)
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Provide any identifying data that will help us locate information about you—for example, your date and place of birth, social security number, former addresses or localities.
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If you are interested in records pertaining to a particular incident you were involved in, please describe it.
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You must sign your request and have it notarized or state, "Under penalty of perjury, I hereby declare that I am the person named above and I understand that any falsification of this statement is punishable under the provisions of Title 18, United States Code (U.S.C.), Section 1001 by a fine of not more than $10,000 or by imprisonment of not more than five years, or both; and that requesting or obtaining any record(s) under false pretenses is punishable under the provisions of Title 5, U.S.C., Section 552a(i)(3) as a misdemeanor and by a fine of not more than $5,000." You may use the:
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State how much you are willing to pay for duplication fees if any are assessed.