City of South Bend Public Records (APRA) Request
Requesting Party's Information
Name of Requesting Party
*
Organization
Address
*
Address
Street Address Line 2
City
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State
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Date of Request
/
Month
/
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Email of Requesting Party
*
example@example.com
Phone Number of Requesting Party
*
Information About This Request
Property Address of Information Requested (If applicable):
Specify Month(s) Requested (If applicable):
Example: January 2024, February 2024
My Request Includes:
Fire/EMS Records
Police Department Records
Date of Incident
*
-
Month
-
Day
Year
Date
Estimated or Exact?
*
Please Select
Exact Date
Estimated Date
Police Record - Person of Interest:
Optional
Person of Interest - DOB:
-
Month
-
Day
Year
Date
EMS - Patient Name:
If Patient is other than Requesting Party
EMS - Patient DOB:
-
Month
-
Day
Year
Date
Requesting Party's Relationship to Case:
Department(s) and Records Requested:
Department Records Requested From:
*
Please Select
Boards/Commissions
Building Department
Fire Department/EMS
Historic Preservation Commission
Human Rights Commission
Neighborhood Services/Enforcement
Police Department
Public Works
South Bend Animal Resource Center
Water Works
Other/I'm Not Sure
Record(s) Requested from Department of Water Works:
*
Record(s) Requested from Building Department:
*
Record(s) Requested from Historic Preservation Commission:
*
Record(s) Requested from SBARC:
*
Record(s) Requested from Department of Public Works:
*
Important:
The City does not have traffic cameras that record videos or photos; the devices placed at these intersections are infrared thermal cameras. These cameras only pick up heat signatures and are used to control the traffic signal at an intersection.
Record(s) Requested from Neighborhood Services/Enforcement:
*
Please Note:
Invoice Records do not constitute a payoff. if you require a payoff of assessments, please contact the Neighborhood Services and Enforcement Division
Record(s) Requested from Fire/EMS Department:
*
I am requesting this EMS record on behalf of:
*
Myself (Only select this if you are listed as the patient on this record)
Someone Else
EMS record requests from a 3rd party must be accompanied by a HIPAA Authorization Form. Please upload this documentation to submit your request.
*
Browse Files
Drag and drop files here
Choose a file
Document must verify that you are a HIPAA authorized 3rd party, otherwise we will not be able to complete your request
Cancel
of
Record(s) Requested from Police Department:
*
Attention:
Requesting audio/video records may significantly delay a response, depending on the number of items to be reviewed and/or redacted. These records may be subject to additional fees that will be invoiced to the requestor and due prior to receiving these records.
Date of Incident (Optional)
-
Month
-
Day
Year
Date
Estimated or Exact?
Please Select
Exact Date
Estimated Date
Additional Information About This Request - Please be Specific
*
0/200
1st Department Request
Add Another Department to this Request?
Yes
No
1. Additional Department
Please Select
Boards/Commissions
Building Department
Fire Department/EMS
Historic Preservation Commission
Human Rights Commission
Neighborhood Services/Enforcement
Police Department
Public Works
South Bend Animal Resource Center
Water Works
Other/I'm Not Sure
Record(s) Requested from Department of Water Works:
Record(s) Requested from SBARC:
Record(s) Requested from Building Department:
Record(s) Requested from Historic Preservation Commission:
Record(s) Requested from Department of Public Works:
Important:
The City does not have traffic cameras that record videos or photos; the devices placed at these intersections are infrared thermal cameras. These cameras only pick up heat signatures and are used to control the traffic signal at an intersection.
Record(s) Requested from Neighborhood Services/Enforcement:
Please Note:
Invoice Records do not constitute a payoff. if you require a payoff of assessments, please contact the Neighborhood Services and Enforcement Division
Record(s) Requested from Fire/EMS Department:
Date of Incident
*
-
Month
-
Day
Year
Date
Estimated or Exact?
*
Please Select
Exact Date
Estimated Date
EMS Patient Name:
EMS Patient DOB:
-
Month
-
Day
Year
Date
I am requesting this EMS record on behalf of:
*
Myself (Only select this if you are listed as the patient on this record)
Someone Else
EMS record requests from a 3rd party must be accompanied by a HIPAA Authorization Form. Please upload this documentation to submit your request.
*
Browse Files
Drag and drop files here
Choose a file
Document must verify that you are a HIPAA authorized 3rd party, otherwise we will not be able to complete your request
Cancel
of
Record(s) Requested from Police Department:
Attention:
Requesting audio/video records may significantly delay a response, depending on the number of items to be reviewed and/or redacted. These records may be subject to additional fees that will be invoiced to the requestor and due prior to receiving these records.
Person(s) of Interest (Optional):
POI Date of Birth:
-
Month
-
Day
Year
Date
Date of Incident (Optional)
-
Month
-
Day
Year
Date
Estimated or Exact?
Please Select
Exact Date
Estimated Date
Additional Information About This Request - Please be Specific
*
0/200
2nd Department Request
Add Another Department to this Request?
Yes
No
2. Additional Department
Please Select
Boards/Commissions
Building Department
Fire Department/EMS
Historic Preservation Commission
Human Rights Commission
Neighborhood Services/Enforcement
Police Department
Public Works
South Bend Animal Resource Center
Water Works
Other/I'm Not Sure
Record(s) Requested from Department of Water Works:
Record(s) Requested from Building Department:
Record(s) Requested from Historic Preservation Commission:
Record(s) Requested from SBARC:
Record(s) Requested from Department of Public Works:
Important:
The City does not have traffic cameras that record videos or photos; the devices placed at these intersections are infrared thermal cameras. These cameras only pick up heat signatures and are used to control the traffic signal at an intersection.
Record(s) Requested from Neighborhood Services/Enforcement:
Please Note:
Invoice Records do not constitute a payoff. if you require a payoff of assessments, please contact the Neighborhood Services and Enforcement Division
Record(s) Requested from Fire/EMS Department:
Date of Incident
*
-
Month
-
Day
Year
Date
Estimated or Exact?
*
Please Select
Exact Date
Estimated Date
EMS Patient Name:
EMS Patient DOB:
-
Month
-
Day
Year
Date
I am requesting this EMS record on behalf of:
*
Myself (Only select this if you are listed as the patient on this record)
Someone Else
EMS record requests from a 3rd party must be accompanied by a HIPAA Authorization Form. Please upload this documentation to submit your request.
*
Browse Files
Drag and drop files here
Choose a file
Document must verify that you are a HIPAA authorized 3rd party, otherwise we will not be able to complete your request
Cancel
of
Record(s) Requested from Police Department:
Attention:
Requesting audio/video records may significantly delay a response, depending on the number of items to be reviewed and/or redacted. These records may be subject to additional fees that will be invoiced to the requestor and due prior to receiving these records.
Person(s) of Interest (Optional):
POI Date of Birth:
-
Month
-
Day
Year
Date
Date of Incident (Optional)
-
Month
-
Day
Year
Date
Estimated or Exact?
Please Select
Exact Date
Estimated Date
Additional Information About This Request - Please be Specific
*
0/200
3rd Department Request
Add Another Department to this Request?
Yes
No
3. Additional Department
Please Select
Boards/Commissions
Building Department
Fire Department/EMS
Historic Preservation Commission
Human Rights Commission
Neighborhood Services/Enforcement
Police Department
Public Works
South Bend Animal Resource Center
Water Works
Other/I'm Not Sure
Record(s) Requested from Department of Water Works:
Record(s) Requested from Building Department:
Record(s) Requested from Historic Preservation Commission:
Record(s) Requested from SBARC:
Record(s) Requested from Department of Public Works:
Important:
The City does not have traffic cameras that record videos or photos; the devices placed at these intersections are infrared thermal cameras. These cameras only pick up heat signatures and are used to control the traffic signal at an intersection.
Record(s) Requested from Neighborhood Services/Enforcement:
Please Note:
Invoice Records do not constitute a payoff. if you require a payoff of assessments, please contact the Neighborhood Services and Enforcement Division
Record(s) Requested from Fire/EMS Department:
Date of Incident
*
-
Month
-
Day
Year
Date
Estimated or Exact?
*
Please Select
Exact Date
Estimated Date
EMS Patient Name:
EMS Patient DOB:
-
Month
-
Day
Year
Date
I am requesting this EMS record on behalf of:
*
Myself (Only select this if you are listed as the patient on this record)
Someone Else
EMS record requests from a 3rd party must be accompanied by a HIPPA Authorization Form. Please upload this documentation to submit your request.
*
Browse Files
Drag and drop files here
Choose a file
Document must verify that you are a HIPAA authorized 3rd party, otherwise we will not be able to complete your request
Cancel
of
Record(s) Requested from Police Department:
Attention:
Requesting audio/video records may significantly delay a response, depending on the number of items to be reviewed and/or redacted. These records may be subject to additional fees that will be invoiced to the requestor and due prior to receiving these records.
Person(s) of Interest (Optional):
POI Date of Birth:
-
Month
-
Day
Year
Date
Date of Incident (Optional)
-
Month
-
Day
Year
Date
Estimated or Exact?
Please Select
Exact Date
Estimated Date
Additional Information About This Request - Please be Specific
*
0/200
4th Department Request
I Request to:
*
Inspect These Records
Buy These Records
I Would Like to Receive These Records via:
*
Email
Regular Mail
In Person Pick Up
Please Note:
"in Person Pick Up" and "Regular Mail" options are subject to copying fees not to exceed the actual cost to produce physical records
Additional Documentation for Request (Optional):
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Additional Information About This Request - Optional
0/200
Please verify that you are human
*
Signature of Requesting Party
*
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