HomeMy WebLinkAbout2024 11 08 PC Lazarevich Release of Record to Law Enforcement Agency Schedule 3 - Law Enforcement Officer Request Form
RELEASE OF RECORD TO LAW ENFORCEMENT AGENCY
(under Section 32, (g) of the Municipal Freedom of Information and Protection of
Privacy Act)
TO: Municipality of Kincardine
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Print Name of Police Officer Print Name of Police Force
request a copy of the following record(s):
Date:(52�Ll - I j - 0 8 Time Period: 11130 _t015_ar9
Municipal Facility: 00L(,tk6�_ cc*1114� ---
(Davidson Centre, Municipal Administration Centre,
Waste Management Centre, Water Treatment Plant)
to aid an investigation undertaken with a view to a law enforcement proceeding or from
which a law enforcement proceeding is likely to result.
I confirm that the record will be destroyed by the Ontario Provincial Police after use by
the agency.
- 0-00C
2s, re of Officer Date
Return completed original forms to the Clerk at the Municipality of Kincardine Municipal
Administration Centre, 1475 Concession 5, RR 5 Kincardine, ON N2Z 2X6.
Personal information is collected under the authority of the Municipal Act, 2001, S.Q. 2001, c, 25 for the
purpose of creating a record relating to release of video surveillance record to law enforcement agency.
Questions about the collection may be addressed to the Clerk of the Municipality of Kincardine, 1475
Concession 5, R.R. 5 Kincardine, ON N2Z 2X6 Phone: (519) 396-3468.
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