APPLICATION FOR ACCESS TO SAPOL RECORDS (FREEDOM OF INFORMATION ACT - SECTION 13) PD360 A FEE MUST ACCOMPANY THIS APPLICATION PROOF OF IDENTITY IS REQUIRED • • Please use BLOCK letters If you need help, ask our staff DETAILS OF PERSON APPLYING FOR ACCESS TO SAPOL RECORDS Name: (Mr, Mrs, miss, ms) MS FteikCE TherCr,i6ELI v•* GA(' . .- DOB: . (F•nisyNerrie) oven NO/TIM3 Residential Address: _ Postcode: EMI Telephone: (Home) (Work) . (Mobile) Fax: COMPLETE THIS SECTION TO HAVE YOUR CORRESPONDENCE FORWARDED TO ANOTHER PERSON Company and contact name: _. Company Address: Postcode.• .... Telephone: F DETAILS OF REQUEST Please describe clearly what you want and include names of any other person(s) involved in incident, dates, times, locations and any other information which will help to identify the document(s). Your personal Involvement in this request must be included. • ST PIT et4E.NTS OF ‘,.“-I-Nesse-s N.Inriet it ketrictOr -1O C-HORGE5 • g.ec-orkos cif Pot % c-e 0 PFI GE-RS 'INVOLVE-0 i v•) SHE IARRESTS f)Plcs i py' 6.cts./t ev.15 • 12 e cnatzr-n I it•ITCPAi I t`A") S • pceese SEE errrncrte 0 • fki•c_raRnEci ei•fors)E. c_nurs Ut Deo rocrr BCE- tat%) n FEerfieneQ, I eirrratienrrs or i r%)-r6 ft g 1 ei.OS IN Relan ON -TO Mi5ELF RepoPr FEES & CHANGES (Cheques ale to be made payable to 'South Australia Police- or 'SA Police') Attached Is a cheque / cash for S being for the fee payable upon ktidgement of this application. I understand that I may be required to pay further processing charges and that I will be supplied with a statement of charges if appropriate. If you wish to claim a reduction or waiver of fees, complete the following section and attach copies of supporting documents to this form (e.g. concession card) I am requesting a E reduction rgwaiver in fees and charges Specify reasons) for claiming exemption: Hen Laid C.e.Re CFI R D - Q NeM Pga__ NA Nit & SIGNA FURE OF APPLICANT (Sign in presence