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2. To request a police report or other record maintained by the police department, either call 608-845-7623 to speak with clerical staff or submit the request electronically using this Open Records Request form.  The Verona Police Department strives to satisfy all requests for records within 10 working days when possible and has a fee structure pursuant to Wisconsin State statute 19.35. In most cases, records are subject to a fee of $0.25 per page, whether disseminated electronically (for which pre-payment is required) or in-person (for which payment can be made at time of pick-up). 

   Upon completion of a record request, a Records Clerk from the Verona Police Department will contact you, via phone, to facilitate payment and confirm dissemination arrangements. Please allow up to 10 business days for a record request to be processed.   

4. First Name
5. Last Name
7. Address1
9. City
10. State
11. Zip
13. Phone Number
15. Best Time to Call

    1. Anytime
    2. Between 8:00 a.m. - 11:59 a.m.
    3. Between 12:00 p.m. - 4:00 p.m.
    4. Between 4:00 p.m. - 8:00 p.m.
17. Email Address*
18. Fax Number (if applicable)
20. SPECIFIC Record Requested

    Provide a detailed description of the records that you are requesting. Be as specific as possible.

22. Involvement Related to Request
    -- Select One --I am requesting a report involving myselfI am requesting a report involving my child I was involved in a traffic crash I am an insurance agent/representative investigating an insurance claimI am an attorney/law firm representing a client in anticipation of litigationOther (specify within details of Specific Record Requested)

    Please select one

23. Record Receipt Options*
    -- Select One --I will pick up and pay for the request (if applicable), in person, at 111 Lincoln Street, Verona WII prefer to have the record faxed to me once my electronic payment is received (if applicable).I prefer to have the record mailed to me once my electronic payment is received (if applicable).I prefer to have the record emailed to me once my electronic payment is received (if applicable).

    Upon completion of compiling this record request, VPD staff will contact you to let you know the request is ready and to request payment. Please select the means by which you prefer to receive the completed request.

25. RECORDS PROCESSED (to be completed by VPD staff)
    ____	Digital File Link @ $5.00:	___________
    ____	Single-sided BLACK/WHITE pages requested @ $0.25 / each:	___________
    ____	Single-sided COLOR pages requested @ $0.50 / each:	___________
    ____	USB storage device requested @ $5.00 to $15.00 /each:	___________
    ____	Postage ($0.50 std. envelope 1-4 pages or $1.00 letter envelope 5+ pages):	___________
    ____	Other – reproduction/locating fees, etc.:	___________
    	TOTAL AMOUNT DUE:	___________

    	OFFICE USE ONLY
    	Current Status	Initials	Date
    ¨	Ready for release (to be emailed):	________	________
    ¨	Ready & Attached (for pick-up, mail, or fax):	________	________
    ¨	In ___________’s Supervisor Bin pending review:	________	________
    ¨	Not yet typed:	________	________

    
    

    Record Custodian’s Initials:	___________
    Approved:	___________
    Denied:	___________
    Letter of Explanation included:	Yes   /   No  /  NA
    Remarks: ______________________________________________________________________________________________
    (If no remarks, records were released as requested, as indicated above.)

    
    

    
    

    
    

    
    

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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field