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Records Request Form
It is the goal of the Holland Police Department to provide the public with access to information defined as public by law or regulation while maintaining the confidentiality of information exempted from release. Please fill out the information below and the records requested will be provided to you. In accordance with M.G.L. Chapter 66, Section 10, the fee for records is as follows. for preparing and mailing a motor vehicle accident report, five dollars for not more than six pages and fifty cents for each additional page; for preparing and mailing a fire insurance report, five dollars for not more than six pages plus fifty cents for each additional page; for preparing and mailing crime, incident or miscellaneous reports, one dollar per page; for furnishing any public record, in hand, to a person requesting such records, fifty cents per page. A page shall be defined as one side of an eight and one-half inch by eleven inch sheet of paper”.  All checks should be made payable to the Town of Holland.

Accident Reports                                  Incident / Other Reports

Report # (if known):
Report # (if known):
Date/Time Occurred:
Date/Time Occurred:
Location:
Location:
Vehicle 1 Plate #:
Incident:
Owner/Operator 1:
Suspect Name:
Vehicle 2 Plate #:
Victim Name:
Owner/Operator 2:

If you are requesting an in house computer system records query as part of a background check please fill out the information below. An in house query is free of charge and you will be notified in writing of the query response provided you have included the appropriate release forms. If a positive response occurs and you wish to obtain a copy of the record(s) please refer back to section 1.

In house records query (information of the person you are requesting to be queried)

Name
Full Address
Date of Birth
SS# (If known)

Please fill out your information below as the person making the request.
Agency / Business Name (if applicable):______________________________________

Name
Full Address
Phone Number
Signature
Date





 
Town of Holland 27 Sturbridge Road, Holland, MA 01521
Phone: 413-245-7108 Fax: 413-245-7037
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