Open Records Request Form

Fill out the form below, print it and mail to:

PORT WASHINGTON POLICE DEPARTMENT
365 N. Wisconsin St.
Port Washington, WI 53074

The form may also be faxed to the police department at 262-377-9648

Your Full Name:
Your Street Address:     Apt.#
Your City:
Your State:       Your ZIP Code:   
Your Phone Number(s):
Under Wisconsin law, a request for access to a public record may not be refused because the person making the request is unwilling to be identified or to state the purpose of the request. See State Statute 19.35(1)(1), Wis Stats. You are being asked to provide the informatin called for above on a voluntary basis.
Description of Record(s):
Please provide approximate dates, type of incident(s), and name of subject(s) involved
Under Wisconsin law, a request for access to a public record is deemed sufficient if it reasonably describes the requested record or the information requested. However, a request for a record without a reasonable limitation as to subject matter or length of time represented by the record does not constitute a sufficient request. See State Statute 19.35(1)(h), Wis Stats.)
Pursuant to Sec. 19.35(4)(B), Stats., you are hereby notified that if your record request was made in writing, a determination denying or limiting that request is subject to review by a writ of mandamus under Sec. 19.37(1), Stats. or upon application to the Wisconsin Attorney General or a District Attorney.

All Information Below Is For Office Use Only
Date Received:____________________

Action Taken:

_____Request Approved In Whole

_____Request Approved In Part*

_____Request Denied*

Date/Time Request Denied/Compiled:

_____________________
Signature:

 Fee Imposed:_______________________

Notification Attempts (Date/Time):







Date Delivered:_____________________
*Attach copy of any written statement of denial by legal custodian (see below).
_____ 1. This portion identifies a juvenile.
_____ 2. This portion names law enforcement personnel. Disclosure will impair their effectiveness in their duties and subject them to harassment and physical injury.
_____ 3. This portion identifies a person. Disclosure of such person in this context would be likely to have a substantial adverse effect on their reputation.
_____ 4. This portion, if released, would result in harm to the public interest which outweighs the legislative policy of allowing inspection of public records.
_____ 5. This portion contains investigative information.
_____ 6. This portion contains confidential information furnished only by a confidential source who has requested anonymity as a condition of supplying this information.
_____ 7. This portion would identify a confidential source and would endanger the life or physical safety of this source.
_____ 8. This portion would identify a confidential source and this would jeopardize a criminal investigation.
_____ 9. This portion will jeopardize an ongoing criminal investigation in that it will disclose evidence.
_____ 10. This portion would disclose the contents of a communication between administrative or executive personnel on matters of policy, the disclosure of which would inhibit the frank and full discussion of matters necessary to set policy.
_____ 11. This portion contains employee performance evaluation data.
_____ 12. This information is unsubstantiated, if released it would unduly damage the reputation of the individual(s) involved.
_____ 13. Other: