-230 Main Street-Brattleboro, Vermont 05301 -
Media Storage Request


In order to better assist you in obtaining the necessary media, please fill out all the information requested below. One request per defendant, if this request is in regards to a traffic crash, plese provide the operators name:

Brattleboro PD case # (example: 05BB01234)


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Defendant's name and date of birth

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Item/s requesting:

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Person requesting (If you're a law office please indicate what firm you represent):


_____________________________________________________________________________________.
Reason for request:

_____________________________________________________________________________________.
Date of request:

_____________________________.
Total payment enclosed:

_____________________________.


Cost per item:

$15.00 - CD/DVD
$45.00 - CD/DVD if it related to a DUI
$15.00 - Audio
$01.00 - Per printed photo
Please attach payment with this form.
We will not process your request without
Payment. Thank you.


Do not fill out anything below this line
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Date item/s provided:

_________________________by_____________________________to___________________________.