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Police Blotter Sample Form DRAFT

This document is a sample police blotter report form containing information about an individual who was arrested. The form includes fields for the name, age, sex, date, time, and location of the incident as well as the name of the arresting officer and a summary of the incident. It also lists the charges against the arrested individual and provides space for additional information. The document notes that Pennsylvania law requires police blotter information, such as names of individuals charged and alleged offenses, to be made public.

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Jessa Mesa
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286 views

Police Blotter Sample Form DRAFT

This document is a sample police blotter report form containing information about an individual who was arrested. The form includes fields for the name, age, sex, date, time, and location of the incident as well as the name of the arresting officer and a summary of the incident. It also lists the charges against the arrested individual and provides space for additional information. The document notes that Pennsylvania law requires police blotter information, such as names of individuals charged and alleged offenses, to be made public.

Uploaded by

Jessa Mesa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Police Blotter Information Report – Sample

Name of Individual Arrested: _________________________________________________________________________________________

Age of Individual Arrested: _____________________________ Sex of Individual Arrested: ______________________________

Date of Incident: _______________________________________________________________________________________________________

Time of Incident: ______________________________________________________________________________________________________

Location of Incident: ___________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

Name of Arresting Officer: ____________________________________________________________________________________________

Summary of Incident: __________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

Charge(s) Against Arrested Individual: ______________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

Additional Information: _______________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

Pennsylvania’s Right-to-Know Law and the Criminal History Record Information Act (CHRIA) are both clear that
police blotter information – i.e., “A chronological listing of arrests, usually documented contemporaneous with the
incident, which may include, but is not limited to, the name and address of the individual charged and the alleged
offenses.” – is public. This sample form, prepared by the Office of Open Records, is designed to help law
enforcement agencies meet those requirements. It also includes additional information which is commonly
released. More information is available on the OOR’s website, www.openrecords.pa.gov

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