Indicates required field Requestor Information Request Date Requestor’s Full Name Requestor’s Mailing Address Address Address 2 City/Town State/Province - None - Alabama Alaska American Samoa Arizona Arkansas Armed Forces (Canada, Europe, Africa, or Middle East) Armed Forces Americas Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ZIP/Postal Code Country - None - Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua & Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia & Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Ceuta & Melilla Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo - Brazzaville Congo - Kinshasa Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czechia Côte d’Ivoire Denmark Diego Garcia Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard & McDonald Islands Honduras Hong Kong SAR China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR China Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar (Burma) Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands North Korea North Macedonia Norway Oman Outlying Oceania Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Samoa San Marino Sark Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia & South Sandwich Islands South Korea South Sudan Spain Sri Lanka St. Barthélemy St. Helena St. Kitts & Nevis St. Lucia St. Martin St. Pierre & Miquelon St. Vincent & Grenadines Sudan Suriname Svalbard & Jan Mayen Sweden Switzerland Syria São Tomé & Príncipe Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad & Tobago Tristan da Cunha Tunisia Turkmenistan Turks & Caicos Islands Tuvalu Türkiye U.S. Outlying Islands U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis & Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Requestor’s Email Address Primary Telephone Number Type of Report Requested Type of Report Requested - Select - Incident Report Motor Vehicle Accident Report Both Incident Report Requestor Information Select all statements that apply to your request. I am: A person named in the report A third party who is not named in the report A member of the media An authorized recipient who may receive the records Name of Person Listed in the Report Third-Party Name/Company/Relationship Media Representative’s Name Media Organization or Outlet Signed Authorization Upload documentation authorizing you to receive the records, when applicable. Accepted formats: PDF, JPG, JPEG, PNG, DOC, and DOCX.One file only.64 MB limit.Allowed types: gif jpg jpeg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 mp4 ogg wav bz2 dmg gz jar rar sit svg tar zip. Motor Vehicle Accident Report Requestor Information I certify that I have reviewed O.C.G.A. § 50-18-72(a)(5) and that I meet at least one of the requirements for release of a Georgia Uniform Motor Vehicle Accident Report. Information About the Records Requested Case Number Enter the GTPD case number, if known. Type of Incident For example: theft, property damage, motor vehicle accident, or lost property. Incident Date Incident Location Provide the building, street, intersection, parking area, or other known location. Names of Involved Persons Provide any names that may help the Records Unit identify the correct report. Description of Records Requested Clearly describe the report, document, or information you are requesting. Delivery Requested documents will be provided via email. Please contact the Records Unit if other arrangements need to be made. Delivery Email Address Enter the email address where the records should be sent. General Information Please review the following before submitting your request:Not all records are subject to release.All request will be responded to within three business days after receiving the request form.Please allow at least three business days after the incident before submitting a request.Records Unit office hours are Monday through Friday, 8:00 a.m.–3:00 p.m.Requests for multiple documents or other types of records may incur additional fees in accordance with O.C.G.A. § 50-18-71. The requester is not charged for the first fifteen minutes of preparation time. You will receive an email of those fees once calculated.Information may be redacted in accordance with applicable Georgia law, including O.C.G.A. § 50-18-72(a). Certification and Electronic Signature I certify that the information provided in this request is true and accurate to the best of my knowledge. I certify that I am legally eligible to inspect or receive the requested records and that I have selected all applicable eligibility statements above. Electronic Signature Enter your full legal name. Typing your name constitutes your electronic signature. Date Signed
