 BEDFORD POLICE REPORT REQUEST FORM
55 Constitution Drive ~ Bedford, NH 03110 ~ (603) 472-5113
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
*PLEASE PRINT* CALL WHEN READY_____ PUT IN MAIL_____
NAME: ___________________________ TODAY’S DATE: __________ TIME: ___________
STREET ADDRESS:___________________________________ PHONE #: __________________
CITY: _______________________ STATE: ________ ZIP CODE: __________
REQUESTOR’S INVOLVEMENT: MV OWNER_____ MV OPERATOR_____
PASSENGER_____ PROPERTY OWNER_____
REQUESTOR REPORTED THE INCIDENT_____ OTHER____________________________
PLEASE SPECIFY TYPE OF REPORT AND INCLUDE REPORT NUMBER:
ACCIDENT REPORT #:_____________ CASE REPORT #:_____________
INCIDENT REPORT #: _____________ OTHER:_____________
DATE OF INCIDENT:_______________ TIME OF INCIDENT:_______________
LOCATION OF INCIDENT:__________________________________________________________
PARTIES INVOLVED:______________________________________________________________
REQUESTOR’S SIGNATURE:_____________________________________________
DISPATCHER TAKING REQUEST:_________________________________________
COPY OF IDENTIFICATION ATTACHED:_______
ADDITIONAL INFO:
**NOTE: YOUR INVOICE FOR THE REPORT WILL BE INCLUDED WITH THE REPORT. INCIDENT REPORTS COST $2.00. ALL OTHER REPORTS COST $10.00 FOR THE FIRST 10 PAGES, AND $1.00 FOR EACH ADDT’L PAGE THEREAFTER.
***By law the Bedford Police Dept. has FIFTEEN (15) days from the date of the accident to complete the face sheets for a report. However, every effort is made to complete the report as soon as possible.***
| 
