ATLANTA POLICE DEPARTMENT

Special Enforcement Section

Information Dissemination Log

Date
Requesting Agency Information:
Requestor’s Name:
Agency:
Reason for Request / Nature of Investigation:

Request:
Granted
Denied
Reason:	(reason for denial if any)

APD Information Released:
File Name:	File Number:
Transmitted to:	Date:

APD Employee Name: (Printed)	APD ID #:
Signature:
Date:
Supervisor Signature:	Date:

Form APD 379 Created 5/12/08

vlivsey

2008-05-12

CITY OF ATLANTA