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2. First Name (optional)
3. Last Name (optional)
5. Address (optional)
7. City (optional)
8. State (optional)
9. Zip (optional)
11. Requestor Contact Information is Optional

    If you have not provided a Phone Number, Mailing Address, or E-Mail with this request, the Cocoa Beach Police Records Division will not be able to contact you about your request.

    Please call the Cocoa Beach Police Records Division at 321 868-3291 for the status of your records request.

13. Phone Number (optional)
14. E-Mail (optional)
16. Date Range of Records Request (e.g. 11-12-13 - 07-12-14)*
18. Records Request - Please provide as much detail as possible about the record(s) being requested *
20. If requesting e-mail addresses, list names to be included
22. Provide terms to search for, to be used for e-mail and electronic records search (such as: "Name", "Topic")
24. Are you aware of any litigation related to the records request?

    1. Yes
    2. No
26. Contact Information Requirements*

    If you have not provided your Phone Number, Address, or E-Mail with this request, the Records Division has no way of contacting you. Please call the Police Records Division at 321 868-3291 to check on the status of your records request. 

    Police Department Records Custodian
    85 S. Orlando Avenue
    P.O. Box 322430,
    Cocoa Beach, Fl. 32932-2430
    E-mail: records@cityofcocoabeach.com

    1. I read the Contact Information Requirements
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28. 1. Receive an email copy of this form.
29. Email address

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