Pitt County Forms Center

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   1717 W. 5th Street Greenville, NC 27834  |  Telephone: (252) 902-3950

   9-1-1 Communications Public Information Audio / CAD Request
    

4. First & Last Name of Requesting Person*
5. Name Of Requesting Company Or Organization*
7. Requester’s Phone Number*
8. Requester’s Email Address*
10. Additional Contact Information
12. Requestor Status*

    1. I verify that I am the caller that placed the 911 call that is being requested.
    2. I am not the caller and I understand that I am receiving a copy of the report /audio that has been redacted in accordance with North Carolina General Statutes.
    3. I am a lawyer requesting the report / audio on behalf of a client and understand that I will receive a redacted copy in accordance with North Carolina General Statutes.
14. Request Type*

    1. Audio Recording
    2. Computer Dispatch Record
15. Call Date & Approximate Time*
    Call Date & Approximate Time

    Call Date & Approximate Time
16. Call Type (Select all that apply)*

    1. Police
    2. Fire

    1. EMS
    2. Other (please note below)
18. Location Address of Incident, Additional Details & Description*
20. Electronic Signature Agreement*

    By checking the “I Agree” box below, you acknowledge and agree that: 
    (1) Your application will not include a traditional handwritten signature; 
    (2) By signing electronically, you authorize your electronic signature to be valid and legally binding with the same force and effect as a handwritten signature; 
    (3) You may be required to provide a traditional signature at a later date; and 
    (4) a valid government-issued ID may be required if requested.

    1. I agree.
22. Electronic Signature*
23. Date*
    Date
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25. Submit

* indicates a required field