UCSD Police Department
9500 Gilman Drive #0017
La Jolla, CA 92093-0017
(858) 534-4361
police.ucsd.edu
Police Report Copy Request
Your Name: _______________________________
Date: ________________________
Address: _________________________________
Phone: _______________________
City, State: _______________________________
Zip Code: _____________________
Your Signature: ____________________________
Case Report/Incident Number: ______________________________________________
Name of Subject on Report: ________________________________________________
Additional Information: ____________________________________________________
____________________________________________________
Method of Delivery:
Pickup
Mailed
Report Rejection Notice
We are unable to fulfill your request for a copy of the police report based upon the following:
____ 1.
Report includes arrest/sex crime/victim or other information that is not
subject to your review. For additional information contact the UCSD Police
Department at (858)534-4361.
____ 2.
We were unable to locate the case with the information you supplied.
Case does not exist or wrong law enforcement agency.
____ 3.
Other (contact number above for additional information)
FOR PD USE ONLY
Status:
Picked-Up: __________
ID#/Initials: _________
Mailed: __________
ID #/Initials: _________
Report Request.doc
Rev. 6/2011