City of South Bend Public Record (APRA) Request

City of South Bend Public Records (APRA) Request
Date of Request

MonthDayYear
Date
The Indiana Access to Public Records Act ("APRA") governs the process to obtain access to public records from the City. To request public records, you must fill out the City's Records Request form below.

For more information, please visit:
City of South Bend Access to Public Records Act ("APRA") FAQ
Requesting Party's Information
Name of Requesting Party*
Organization
Address*

Address

Street Address Line 2

CityState

Zip
Email of Requesting Party*
example@example.com
Phone Number of Requesting Party*

Information About This Request
I am Requesting Records From:

Police Department
Fire Department/EMS
Requesting Party's Relationship to Case:
Police/Fire/EMS
Other Departments:
1st Department Request
Add Additional Departments to this Request?*

YesNo
2nd Department
2nd Department Request
3rd Department
3rd Department Request
4th Department
4th Department Request

Department(s) and Records Requested:
Property Address for this Request:
Specify Month(s) Requested:
Example: January 2024, February 2024
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 South Bend Animal Resource Center:*
Record(s) Requested from Department of Public Works:*

Record(s) Requested from Neighborhood Services/Enforcement:*

Police Department Records Request

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.

Record(s) Requested from Police Department:
Date of Incident:

MonthDayYear
Date
Location or Address of Incident:
Please enter a Location or Address
Person of Interest:
Optional
Person of Interest DOB:

MonthDayYear
Date
Clone Record(s) requested from Police Department

Case ReportAccident ReportCalls for ServiceBody Worn Camera FootageDash Cam Footage911 Calls/AudioPhotographsOther
PD Requested Documents
All requests to inspect or copy a law enforcement recording must identify with reasonable particularity the recording being requested (see IC 5-14-3-3(i)).

To meet this standard, you must provide the following information:
- Date of law enforcement activity
- Approximate time of law enforcement activity
- Location or address of law enforcement activity
- Name of one person directly involved with the law enforcement activity (may not include the law enforcement officer who was directly involved in the law enforcement activity)
Date and Approximate Time of Law Enforcement Activity:

MonthDayYear
Date
Hour MinutesAM/PM Option
Location or Address of Law Enforcement Activity:
Please enter a Location or Address
Name of one person directly involved in incident
May not include the law enforcement officer directly involved in the law enforcement activity

Dash/BWC Information:

	Label
Dash/BWC
Date/Appx Time
Location
Name of Person

Fire Department/EMS Records Request

3rd Party Requests for EMS Records must include a HIPAA Authorization form for each EMS patient listed on the record.
Record(s) Requested from Fire/EMS Department:
Date of Fire/EMS Incident

MonthDayYear
Date
Location of Fire/EMS Incident:
Please enter a Location or Address
EMS - Patient Name:
EMS - Patient DOB:

MonthDayYear
Date
Add Additional Patients?

YesNo
2. EMS - Patient Name:
If Patient is other than Requesting Party
2. EMS - Patient DOB:

MonthDayYear
Date
3. EMS - Patient Name:
If Patient is other than Requesting Party
3. EMS - Patient DOB:

MonthDayYear
Date
4. EMS - Patient Name:
If Patient is other than Requesting Party
4. EMS - Patient DOB:

MonthDayYear
Date
I am requesting EMS records on behalf of:

Myself (Only select this if you are listed as the patient on this record)Someone Else
3rd Party Requests for EMS Records must include a HIPAA Authorization form for each EMS patient listed on the record. Please upload this documentation to submit your request.

Cancelof
Fire/EMS Requested Documents

Finalize Request
Additional Information About This Request - Please be specific

0/400
Additional Documentation for Request (Optional):

Cancelof
I Request to:*

Inspect These RecordsBuy These Records
I Would Like to Receive These Records via:*

EmailRegular MailIn Person Pick Up

"In Person Pick Up" and "Regular Mail" options are subject to copying fees not to exceed the actual cost to produce physical records

By typing my name in the boxes below, I agree that I am electronically signing this form. I affirm that the information I've provided is accurate and true to the best of my knowledge. I understand that my electronic signature is legally binding and equivalent to my handwritten signature.
Type your Name to Sign Electronically: *

First NameLast Name
Signed Electronically:*

MonthDayYear
Date
Hour MinutesAM/PM Option
Please verify that you are human*
Should be Empty:

City of South Bend Public Records (APRA) Request

Requesting Party's Information

Information About This Request

Department(s) and Records Requested:

Police Department Records Request

Fire Department/EMS Records Request

Finalize Request