Records Request Form

Please Fill out the Form Below to Submit a Formal Request of Records from the Burlington Police Department.

Requester Information

Business/Agency

Agency/Business making request, if applicable.

First Name *

First Name of Requester Submitting Form

Last Name *

Last Name of Requester Submitting Form

Phone Number *

Phone Number of Requester Submitting Form

Email Address *

Email Address of Requester Submitting Form

Incident Detail

The following pertains to the Incident

Incident Number

Date of Incident

Year

Month

Day

Time of Incident

Hour

Minute

Were you Involved in the Incident? *

Yes

Date of Birth

Year

Month

Day

Please provide your Date of Birth

Other Parties Involved

First Name

First Name of Additional Party Involved

Last Name

Last Name of Additional Party Involved

Do you have their Date of Birth?

Yes"

No"

Date of Birth *

Year

Month

Day

Please enter Date of Birth for this Party

Are there Additional Parties Involved?

Yes"

No"

First Name

First Name of Additional Party Involved

Last Name

Last Name of Additional Party Involved

Do you have their Date of Birth?

Yes"

No"

Date of Birth *

Year

Month

Day

Please enter Date of Birth for this Party

Additional Information *

Please Specify the Information that you are requesting.

Select Request Type *

General Incident(s) Request

Accident Report Request

Person History Request

Address History Request

Ticket/Citation Reprint Request

P&P Request

Outside Agency Request

If you would like to add attachments to your request, you may do so now. You can also reply to your confirmation email with these items.

Attachment 1

Files must be less than 10 MB.
Allowed file types: jpg jpeg png pdf doc docx.

Attachment 2

Files must be less than 10 MB.
Allowed file types: jpg jpeg png pdf doc docx.

Attachment 3

Files must be less than 10 MB.
Allowed file types: jpg jpeg png pdf doc docx.

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Contact BPD

Burlington Police Department
Antonio B. Pomerleau Building
One North Avenue
Burlington, VT 05401

Phone: 802-658-2700

Emergency: Dial 911

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Burlington Police Department - Antonio B. Pomerleau Building - One North Avenue - Burlington, VT 05401 - (802) 658-2704
Emergency Call 911

THECITY
OFBURLINGTON

City Hall
149 Church Street
Burlington, VT 05401
Hours: M-F 8am-4:30pm

(802) 865-7000

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