Sheriff Body Camera Public Information Request

Bartholomew County Sheriff's Office, INDIANA
Request For Access to LAW ENFORCEMENT RECORDINGS (Body Camera and Vehicle Camera)
Pursuant to Indiana Access To Public Records Act (I.C. 5-14-3-1, et seq., as amended)
***SEPARATE FORM REQUIRED FOR EACH LAW ENFORCEMENT RECORDING REQUESTED***

Date of Request:

Name of Person requesting information:

Address

Phone:

Fax:

Email:

Organization

IC 5-14-3-5.1 Requestor For purposes of determining whether you are making this request as a “Requestor” under IC 5-14-3-5.1.

Please check all that apply:

I am an individual depicted in the law enforcement recording I am the surviving spouse or an immediate family member of a person depicted in the law enforcement recording who is now deceased (Please fill the name of the deceased field located below) I am the personal representative or attorney for the estate of a person depicted in the law enforcement recording who is now deceased (Please fill the name of the deceased field located below) I am the legal guardian, attorney, or attorney-in-fact (under Power of Attorney) of a person depicted in the law enforcement recording who is an “incapacitated person” under IC 29-3-1-7.5 (Please fill the name of the incapacitated field located below) With regard to real estate the interior of which is depicted in the law enforcement recording I am: An Owner (Please fill the Address of real estate located below) With regard to real estate the interior of which is depicted in the law enforcement recording I am: A Tenant,lessee, or occupant at the time of the recording (Please fill the Address of real estate located below) I am a victim of a crime and events relevant to that crime are depicted in the recording I am a person who has suffered a loss due to personal injury or property damage and the recording depicts events relevant to my loss None of the above descriptions apply to me.

Name of deceased person:

Name of incapacitated person:

Address of real estate:

Please identify the Law Enforcement Recording. All items marked with an asterisk (*) are required.

*DATE of Law Enforcement Activity:

*Approximate TIME of Law Enforcement Activity

*Specific LOCATION of Law Enforcement Activity:

*NAME of at least one non-officer involved

Other relevant info:

Mode of Access

I wish to VIEW the recording using the agency’s equipment I wish to obtain a COPY of the recording

Initial Response: I understand that the Access to Public Records Act requires an initial response to my request within a specified time period, but does not require the agency to provide the copies or access to view the recording within a specified time period; the copy or access will be provided within a reasonable period of lime after the initial response to my request.

Denial of Request: Denial of Request: I understand that if the request is denied, the Bartholomew County Sheriff's Officewill respond in writing and state the statutory exception authorizing the withholding of all or part of the public record and the name and title or position of the person responsible for the denial.

  The Bartholomew County Sheriff's Office may provide me with its response to this request:

by MAIL at:

by FAX at:

by EMAIL at:

Records that do not exist: I understand that an agency is not required to create any record(s) in response to a request. An agency is only required to disclose records that exist at the time the request is made.

Charges: The charge for copies of Law Enforcement Recordings is $150 per recording.Other charges may apply to cover direct costs of reproducing records using other media, and for viewing records access pursuant to IC 5-14-3-3.6 or 5-14-3-5.1. A fee will be charged for the certification of records and for the facsimile transmission of records. Postage will be charged for mailing the requested records to you. To avoid postage charges, you may pick up documents in person or send a self-addressed, stamped envelope. All charges must be paid to the Bartholomew County Sheriff's Office before the requested records will be provided.

NOTICE: All charges must be paid to the Bartholomew County Sheriff's Office before the requested records will be provided. Any Individual that is in the video you are requesting may be notified of your request.

Email a copy of this message to your own address

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