Records Request -

Name *

First

Last

Date Of Request *

Address *

Street, City, County, State, Zip

Phone Number *

Email *

Relation to case *

Suspect, Victim, Attorney, Interest Person, Etc.

Case Number *

Must have Bent County Sheriff's Office Case Number

Date and time of incident *

If you are unsure please provide a date range as close as you can.

Location of incident *

Person the report involves and their ages *

Type of request *

Additional Information

USE OF THIS INFORMATION IS REGULATED BY LAW - DO NOT DISSEMINATE Note: According to Colorado Revised Statute 24-72-305.5, records of official action, criminal justice records, or the names, addresses, telephone numbers, and other information in such records shall not be used by any person for the purpose of directly soliciting business for pecuniary gain. A violation of the section subjects you to misdemeanor charges and upon conviction, a fine of $100.00 or 90 days in jail or both. *

I understand

I affirm that I will not ise the records, or any portion of the records request for the purpose of directly soliciting business for pecuniary. *

Affirm

Checking this box is my digital signature

I understand this records request will cost $5.00 for the first 10 pages, then $0.50 per page beyond 10. Exception: There is no costs assessed to victims of the report request. *

I Understand

You will receive an email or phone call from our Office detailing the estimated cost of your request. The Bent County Sheriff's Office Will not complete your request until payment has been received. Checks shall be made payable to the Bent County Sheriff's Office. Checks can be mailed to the Bent County Sheriff's Office 11100 County Road GG.5, Las Animas, Colorado 81054 or drop of the check or cash. (We do not accept Credit or Debt Cards at this time)

How would you like to receive these records? *

Email
Fax
Printed (Picked Up)
Printed (Mailed) (Postage costs will be added)

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