Pd 542 061 Form – Fill Out and Use This PDF

VERIFICATION OF CRIME/LOST PROPERTY

PD 542-061 (Rev. 05-19)

Requests for Verification of Crime/Lost Property reports from complainants/victims, their authorized representative, or an authorized third party will be completed free of charge. Complainants/Victims designating an authorized representative must also complete and submit a notarized AUTHORIZATION LETTER [page 2]. All applicants must enclose a stamped self-addressed envelope. Please mail requests to: New York City Police Department, Criminal Records Section (Verification Unit), 1 Police Plaza, Room 303, New York, NY 10038. Complainants/Victims can also request a copy of a Verification of Crime/Lost Property report by submitting their request online at https://www1.nyc.gov/site/nypd/services/law-enforcement/record-requests.page. In order to find this record you

MUST furnish all information requested below, particularly the complaint number and precinct of record (occurrence).
Verification of your request cannot be made without this information. The complaint number may be obtained by calling
the precinct or detective squad concerned during the hours of 7 a.m. to Midnight.							F O R U S E B Y N Y P D
* Complaint Number			* Precinct of Report			Exact location where crime took place
Mail Record To:						Full name and address of complainant/victim as reported to Police Department
(Print or Type)
Date reported to Police		Time (if known)			This report concerns:  Crime		 Lost Property
					 Other (describe)
Date and Time of Crime /	Date			Time	Name of officer who received your report, if known.
Loss of Property (if different
than date of report)

Any additional information which may aid in searching for your record

FOR POLICE DEPARTMENT USE ONLY – DO NOT WRITE BELOW THIS LINE

THE FOLLOWING IS A VERIFICATION OF THE ABOVE REQUEST INCLUDING PROPERTY INVOLVED

Raised seal required for validation

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LETTER OF AUTHORIZATION FOR VERIFICATION OF CRIME/LOST PROPERTY REQUEST

(Only complete if designating an authorized representative)

Complainant/Victim’s Name: _______________________________________________

Address:

Date of Occurrence: __________________________

Precinct of Occurrence: _______________________

Location Crime/Loss Occurred: ____________________________________________________________

Name of Authorized Representative: _______________________________________________________

Authorized Representative’s Address:

To: New York City Police Department, Criminal Records Section (Verification Unit) 1 Police Plaza, Room 303, New York, NY 10038

This letter confirms my designation of the individual or firm listed above as my authorized representative to act on my behalf for the sole purpose of requesting crime/lost property information from the New York City Police Department in connection with the above-captioned occurrence and the accompanying completed Verification of Crime/Lost Property (PD 542-061) form. My authorized representative is hereby granted the right of access to information and the right to act as my agent regarding this request, and all communications sent by the New York City Police Department in regards to this request should be directed to the attention of the authorized representative. However, this does not preclude my intervention at a future date, and this authorization may be revoked, in writing, by me at any time.

I understand that when releasing information to the authorized representative, the New York City Police Department has no authority to control the future use or dissemination of this information. Therefore, I release the New York City Police Department, the City of New York and any officers, agents, or employees, thereof, from any and all liability that may arise out of the authorized representative’s possession and the use of the information and records.

This written authorization is effective the date signed and will remain in effect until the request has been completed or the authorization is revoked by me, in writing, whichever occurs first.

__________________________________	_________________
Complainant/Victim’s Name (Please Print)	Date
__________________________________
Complainant/Victim’s Signature

STATE OF NEW YORK

SS.:

COUNTY OF _______________________

On the ________ day of ____________________ in the year 20 _____ before me, the undersigned, personally

appeared ____________________________________________________________, personally known to me

or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her capacity, and that by his/her signature on the instrument, the individual, or the person upon behalf of which the individual(s) acted, executed the instrument.

___________________________________________	[Affix Notary Stamp]
Notary Signature

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