Henley CCTV Request Form (Law Enforcement)

Law Enforcement Video Request Form

Complete this form only if you are a law enforcement officer requesting CCTV video related to a law enforcement investigation

ALL OTHER LAW ENFORCEMENT REQUESTS WILL REQUIRE A SUBPOENA OR COURT ORDER

Law Enforcement Requestor Information

Current Coordinates

Requested Location (ie Store)

Search By Current LocationSearch By Address

Requested Location (ie Store)

Search By Current Location

Requesting Agency

Requestor Address

Requestor City

Requestor State

Requestor Zipcode

Requesting Individual

Requestor Phone

Requestor Email

Individual Title/Position

Do you have a badge number?

Yes No

Individual BadgeNo

Proof of position

Incident Date (YYYY-MM-DD)

Vehicle Make (If Applicable)

Vehicle Model (If Applicable)

Vehicle Year (If Applicable)

Vehicle Color (If Applicable)

Reason(s) for requesting CCTV footage

Please define the scope of the CCTV request. (i.e. Date, Time, Camera Location, Specific Areas of Interest, other pertinent information etc.)

Under penalty of perjury, I affirm that I am the law enforcement official referenced above and that to the best of my knowledge, the information provided is true and accurate.

Sign below to acknowledge