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2. Name*
4. Phone Number (numbers only, no dashes)*
6. Email Address*

8. Please provide all known information to assist in locating requested documents/videos.

10. Documents (Check all that apply)*

    Please note, Private Lot Accident does not apply to accident reports. Request an accident report.

    1. Incident Report
    2. Arrest Report

    1. Private Lot Accident
    2. Other
12. Specify Other
14. Media (Check all that apply)*

    1. BWC
    2. ICV
    3. MDOT

    1. Photos
    2. Other
16. Specify Other
18. Date of Request*
    Date of Request
20. Incident Date*
    Incident Date
22. Incident Location*
24. CAD / Offense Number
26. Officer(s) Involved
28. Ticket Number(s)
30. Defendant's Name(s)

32. I understand that the City of Southaven will apply a charge of $10 per written report.

    For media requests the minimum charge per incident is $25.

    All documents will be delivered via email.

34. This option applies to media delivery only.

    1. I wish an emailed link (to the email address listed above), enabled for 72 hours upon sending to recipient, which may be downloaded by recipient. I understand the cost is based on $25 per hour to prepare the media.

36. The redaction process of SPD Public Record Request of body and in-car video is a time-consuming and tedious process. Petitioner will be provided with cost estimates prior to the initial review of media and the redaction process.

Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field