Transcription of DPS-96-c Request For Copy Of Report Rev 7-18-11
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DPS-96-c Request For Copy Of Report Rev 7-18-11
State of connecticut DEPARTMENT OF EMERGENCY SERVICES & PUBLIC PROTECTION DIVISION OF STATE POLICE An Affirmative Action/Equal Employment Opportunity Employer DPS-96-c (Rev. 7/11) Request for copy of Report Name of Person Requesting Report copy : (First, MI, Last) Mailing Address: (Street / P. O. Box) City, State Zip Code (Many accident reports may also be obtained on the internet at ) Enclose search fees ( 29-10b) by check or money order payable to "Treasurer State of CT" in the proper amount: Indicate the number of uncertified reports requested: per Request Indicate the number of certified reports requested: per Request Total Amount: $ E-Mail Address:_ (Optional) Please note, by providing an e-mail address you agr
State of Connecticut DEPARTMENT OF EMERGENCY SERVICES & PUBLIC PROTECTION DIVISION OF STATE POLICE An Affirmative Action/Equal Employment Opportunity Employer
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