Required fields are marked with asterisks (*)

Law Enforcement Request for Personal Information

Under section 32(g) of MFIPPA, The Corporation of the Municipality of Leamington may disclose personal information to an institution or a law enforcement agency in Canada to aid an investigation undertaken with a view to a law enforcement proceeding or from which a law enforcement proceeding is likely to result.

If you require personal information for law enforcement purposes and you believe the information is in the custody or control of The Corporation of the Municipality of Leamington, please complete this form and submit it to the Clerk, Municipality of Leamington, 111 Erie Street N, Leamington, ON, N8H 2Z9 Tel: 519-326-5761 or by email at: clerks@leamington.ca.

Part A: Requester's Information (to be completed in full by law enforcement officer)

Title

First Name

Last Name

Badge no. (If applicable)

Name of Law Enforcement Agency

Investigation Number

Email Address

Address of law enforcement agency

City or Town

Province

Postal Code

Daytime telephone number

Please specify the type of records you are requesting with reference to incidents or persons, if known. If applicable, provide an estimated time period in which the records would have been created.

Please provide a general description of the investigation. Avoid reference to identifiable persons except where necessary to search for the records.

If you wish to provide any other details that may assist in fulfilling your request, please provide them below:

Preferred method of access to records

Yes

Please state any objections you may have to the Municipality of Leamington notifying persons identified in the records that their personal information has been disclosed to your agency.

Please specify the level of access you are requesting:

Certified Copy

Electronic Copy

Excerpt (by email)

Signature of Investigating Officer

Clear

By signing here, you are certifying that the above information is true and correct and that this request is made as part of an ongoing investigation with a view to a law enforcement proceeding, criminal or otherwise.

Date of Signature

Personal information contained on this form is collected under s. 28(2) of the Municipal Freedom of Information and Protection of Privacy Act and will be used to respond to your request. Questions about this collection should be directed to: Clerk, the Corporation of the Municipality of Leamington, 111 Erie Street N, Leamington, ON N8H 2Z9, Telephone: 519-326-5761.

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