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2. IMPORTANT INFORMATION
   Complete this form to obtain a copy of a police report you have already reported to the Scarsdale Police. If you need to report an incident to the Scarsdale Police, call (914) 722-1200 anytime.
4. Number of Report (if known)
6. First Name*
7. Last Name*
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number
16. Fax Number
18. Email Address*
20. Requestor's Driver License Number
22. Date and Time of Incident or Accident
    Date and Time of Incident or Accident

    Date and Time of Incident or Accident
24. Location of Incident or Accident
26. Your Involvement in the Incident
28. Description of Incident Report
30. Type of Report Being Requested*

    1. Police Incident Report
    2. Fire Incident Report
    3. Police Accident Report
34. Operator's Name
36. Operator's Drivers License Number
38. To obtain an Accident Report, the applicant must be one of the following: (check one)

    1. Person involved in accident
    2. Executor or Adminstrator of Estate
    3. Family member of involved
    4. Insurer
    5. Party in legal action due to the accident
    6. Other (explain)
40. Accident Report Other Explanation
42. Driver's Privacy Protection Act

    You must have a permissible use (defined in the Driver's Privacy Protection Act) to receive a copy of an accident report. I certify that I will comply fully with the terms of the Driver's Privacy Protection Act (18 USC Sec 2721 et. Seq.). I also certify that I will not request or use any information provided by the Scarsdale Department of Public Safety that is not specifically authorized by the Driver's Privacy Protection Act. Accident report requests without the above Driver's Privacy Protection Act information completed will not be completed.

    1. Click here to agree to the terms of the Driver's Privacy Protection Act (required for accident reports)
44. Desired Delivery Method for Report*

    1. Postal Mail (to address listed above)
    2. Email (to address listed above). Please note reports will be emailed as PDF attachments and required Adobe Reader to View and Print.
    3. Fax (to fax number listed above)
    4. Left for pickup at Police Department (Fenimore & Tompkins Roads) Please note that you will be notified when the report is ready for pickup
46. Certification*

    I certify under penalty of law that all the information provided in this report request form is true and accurate. I acknowledge that knowingly making a false statement or concealing a material fact in this submission is a criminal offense punishable under the New York State Penal Law Section 210.45. I understand that the I/P address associated with the computer submitting this request will be captured and stored with the request.

    1. Click this box to acknowledge the above certification (required to complete report request)
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field