Online Forms

2. This is the public records request name record check form for the Eugene Police Department. Please fill out this form completely to the best of your ability. The more information you provide, the easier it is for us to complete your request in a timely manner.
4. Please fill out one request form for each different request.
6. Requester First Name*
7. Requester Last Name*
9. Business Name
11. Address 1*
13. Address 2
15. City*
16. State*
17. Zip*
19. Phone Number*
20. Extension
21. Email Address*
23. Subject of Request*

    1. Self
    2. Someone else
24. Full Date of Birth*
26. Type of Contact *

    1. All with juvenile
    2. All without juvenile
    3. Derogatory
27. Version*

    1. Regular
    2. Notarized
    3. Certified
28. Version*

    1. Regular
    2. Notarized
    3. Certified
30. Subject First Name*
31. Subject Last Name*
33. Subject Date of Birth*
35. Any Additional Information
    Please provide any additional information about the records you are requesting.
37. Signature of person making the request*
39. Do you agree?*

    By clicking I agree, you agree and acknowledge that 1) your application will not be "Signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your electronic signature is valid and binding upon you to the same force and effect as a handwritten signature.

    1. I Agree
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field