INSTRUCTIONS:

Active/Defunct: If "Active" is selected, the form is still being used by the City. Defunct forms are outdated or no longer used.

Internal: If "Yes" is selected, the form is used by City of Philadelphia employees.

External: If "Yes" is selected, the form is used by the general public.

Electronic: If "Yes" is selected, this form is stored electronically and indexed.

Automated: If "Yes" is selected, the form information can be filled out and submitted via a computer system.

Form Number Form Name Active/Defunct Internal75-10 Extract of Criminal Record75-10A Extract of Juvenile Contacts75-112 Evaluation Report75-116 Criminal Registration Certificate - English75-116-Ar Criminal Registration Certificate - Arabic75-116-Ca Criminal Registration Certificate - Cambodian75-116-Ch

75-116-Ko Criminal Registration Certificate - Korean75-116-Ru Criminal Registration Certificate - Russian75-116-Sp Criminal Registration Certificate - Spanish75-116-Vi Criminal Registration Certificate - Vietnamese75-118 Complaint and Assignment Journal75-122 Evidence for Court Tag75-124

75-125 Seizure Analysis Report75-133 Municipal Court Hearing List75-140 Abandoned Vehicle Report - English75-140-Ar Abandoned Vehicle Report - Arabic75-140-Ca Abandoned Vehicle Report - Cambodian75-140-Ch Abandoned Vehicle Report - Chinese (Traditional)

75-140-Ko Abandoned Vehicle Report - Korean75-140-Ru Abandoned Vehicle Report - Russian75-140-Sp Abandoned Vehicle Report - Spanish75-140-Vi Abandoned Vehicle Report - Vietnamese75-144 Confiscated Label75-147

75-148 Seal for Liquor Bottle75-153

75-156 Gasoline and Oil Delivery Receipt

Review the list of forms below and fill out all information in the white areas as completely as possible. If there are any forms for your department that are NOT listed, please add those forms to the "Additional Forms" section in the bottom in this spreadsheet. Please do NOT create your own spreadsheet or your own excel workbook - only this spreadsheet will be accepted.

Criminal Registration Certificate - Chinese (Traditional)

Summary of Motor Vehicle Accidents and Hazardous Violation. Report

Request for Cancellation of Uniform Traffic Summons & Complaint

Request for Photograph / Extract of Criminal Record, etc.

75-158 Patrol Activity Log75-159

75-163 Juvenile Aid Division Record75-163A Youth Referral Program75-164 Traffic Violation Report - Ticket Transmittal List75-167 Record of Sales of Firearms75-167A Application for Purchase of Firearms75-169 Complaint or Incident Report Transmittal List75-173 Motor Vehicle Operator's Record75-175

75-178 Court Notice75-18

75-184 Prisoner Master Index Card75-184A Prisoner Alias Index Card75-185 Court Busy Notice75-189 Control Log75-192 Assignment Sheet75-192A Tactical Foot Patrol Assignment Report75-197 Criminal Record75-198 Warrant Record75-199A Palmprint Card75-213 Report of Accident Involving City of Philadelphia75-214A Commission - Security Officer75-225 Negative Envelope75-225A Negative Envelope - Police Personnel75-229 Biographical Information Report75-23 Code Violation Notice75-232 Investigator's Activity Log75-234 Pawn Shop Notice75-242 Extract of Police Report of Incident or Offense75-243

75-245 Envelope - Evidence for Court75-25 Journal Of Robberies75-250 Business Information Record - By Name75-250A Business Information Record - By Address75-254 Alias Index75-269 Application for Transfer75-277 Prisoner Log - Police Detention Unit75-281 Notice of Hearing75-293 Bicycle Display Notice - English75-293-Ar Bicycle Display Notice - Arabic75-293-Ca Bicycle Display Notice - Cambodian75-293-Ch Bicycle Display Notice - Chinese (Traditional)75-293-Ko Bicycle Display Notice - Korean75-293-Ru Bicycle Display Notice - Russian75-293-Sp Bicycle Display Notice - Spanish75-293-Vi Bicycle Display Notice - Vietnamese

Tab Card - Radio Complaint Message and Incident Report

Application for Search Warrant (Part 1) and Search Warrant (Part 2-6)

Statement of Charges Filed and Action Taken - Police Department

Accident Investigation District Case Record Envelope

75-294 Homicide Case Summary75-297 Prisoners Log - District Cell75-298 Roll Call Complaints75-299 Evidence Received (Bound Book)75-3 Property Receipt75-300 Discipline Record75-302 Application for Commission75-303 Security Officer Commission75-304 Notification of Oath of Office75-305 Mobile Crime Detection Service Report75-307 Supplemental Traffic Violation75-313 Traffic Assignment and Enforcement Record75-315A Envelope - Police Negative75-319 Court Appearance Request75-326 Bound Book75-328 Homicide Record75-331 Statement Cover Sheet75-331A Page 1 of Statement75-331D Statement - Warning Questions - Page 1 - English

75-331D-Ar Statement - Warning Questions - Page 1 - Arabic

75-331D-Ca

75-331D-Ch

75-331D-Ko Statement - Warning Questions - Page 1 - Korean

75-331D-Ru

75-331D-Sp

75-331D-Vi

75-331E Statement - Warning Questions - Page 2 - English

75-331E-Ar Statement - Warning Questions - Page 2 - Arabic

75-331E-Ca

75-331E-Ch

75-331E-Ko Statement - Warning Questions - Page 2 - Korean

75-331E-Ru

75-331E-Sp

75-331E-Vi

Statement - Warning Questions - Page 1 - CambodianStatement - Warning Questions - Page 1 - Chinese (Traditional)

Statement - Warning Questions - Page 1 - RussianStatement - Warning Questions - Page 1 - SpanishStatement - Warning Questions - Page 1 - Vietnamese

Statement - Warning Questions - Page 2 - CambodianStatement - Warning Questions - Page 2 - Chinese (Traditional)

Statement - Warning Questions - Page 2 - RussianStatement - Warning Questions - Page 2 - SpanishStatement - Warning Questions - Page 2 - Vietnamese

75-334

75-337 School Crossing Guard Attendance75-341 Bicycle Inspection Report75-342 Car Wash Certificate Record75-343 Police Records Check75-344 Letter of Good Conduct75-349 Daily Attendance Report75-350 Personal Data Summary75-350B Change of Address, Name or Personnel Data75-353 Laboratory Analysis Record75-359 Request for Re-Arrest75-370 Vice Report75-374 Investigator's Case Log75-382 Curfew Violation Notice75-385 Code Violation Notice Transmittal List75-390 Search Warrant Control Log75-391 Mail Register75-400 Detective Bureau Personnel Reference75-402 Notice of Vehicle in Police Custody75-411 Juvenile Release - English75-411-Ar Juvenile Release - Arabic75-411-Ca Juvenile Release - Cambodian75-411-Ch Juvenile Release - Chinese (Traditional)75-411-Ko Juvenile Release - Korean75-411-Ru Juvenile Release - Russian75-411-Sp Juvenile Release - Spanish75-411-Vi Juvenile Release - Vietnamese75-412

75-414 Radio Call Not Acknowledged75-421 Activity Report - Police Community Relations Div.

75-423 Overtime Authorization and Certification - Civilian

75-424 Property Receiving Report75-427 Compensatory Time Accrual Control75-429 Authorization for Outside Employment75-430 T.V.R. Control75-431 Statement of Accrued Time Balances75-432 Recall Report75-434 Notice to Remove75-438 Building Entry and Exit Register75-439

75-439-Ca

75-439-Po

75-439-Ru

Comparative Report of Motor Vehicle Accidents & Type of Accident

Application for Permission & Author. To Leave Residence During Sickness

Report of Chemical Test for Defendants Charged with 3802 V.C. - EnglishReport of Chemical Test for Defendants Charged with 3802 V.C. - CambodianReport of Chemical Test for Defendants Charged with 3802 V.C. - PolishReport of Chemical Test for Defendants Charged with 3802 V.C. - Russian

75-439-Sp

75-439-Uk

75-439-Vi

75-440 Intoxication Release Certificate - English75-440-Ar Intoxication Release Certificate - Arabic75-440-Ca Intoxication Release Certificate - Cambodian75-440-Ch

75-440-Ko Intoxication Release Certificate - Korean75-440-Ru Intoxication Release Certificate - Russian75-440-Sp Intoxication Release Certificate - Spanish75-440-Vi Intoxication Release Certificate - Vietnamese75-443 Increment Record75-446 Leave Time Accrual - Separated Employee75-447 Request to Resign75-448 Separation Check List75-451 Vehicle Maintenance Report75-452 Request Referral to Compensation Clinic75-456 Meter Parking Violations75-459 Hit and Run Summary75-46 Accident Complaint Activity Report75-460 Comparison of Motor Vehicle Accidents75-462 Injury Record75-465 Physical Evidence Control Data75-465A Evidence Control Data75-469 Police Application Control Card75-473 Polygraph Examination Reference File75-474 Polygraph Exam. Complainant File75-475 Polygraph Examination - Consent - English75-475-Ar Polygraph Examination-Consent - Arabic75-475-Ca Polygraph Examination-Consent - Cambodian75-475-Ch

75-475-Ko Polygraph Examination-Consent - Korean75-475-Ru Polygraph Examination-Consent - Russian75-475-Sp Polygraph Examination-Consent - Spanish75-475-Vi Polygraph Examination-Consent - Vietnamese75-476 Polygraph Exam. Agreement75-477

75-48 Complaint of Incident Report75-480 Enforcement Index and Comparison75-481 Expressway Accident and Comparison Report75-483 Investigation Interview Record75-483A Investigation Interview - Continuation Sheet75-484 Car Log75-485 Chronology of Interrogation and / or Custody

Report of Chemical Test for Defendants Charged with 3802 V.C. - SpanishReport of Chemical Test for Defendants Charged with 3802 V.C. - UkrainianReport of Chemical Test for Defendants Charged with 3802 V.C. - Vietnamese

Intoxication Release Certificate - Chinese (Traditional)

Polygraph Examination-Consent - Chinese (Traditional)

Polygraph Examination - Pre-Test Background Check

75-487

75-48C Philadelphia Non-Reportable Accident Report75-49 Investigation Report75-491

75-492

75-493 Tow Truck Log75-49A Investigation Report Work Sheet75-5 Evidence / Personal Property Tag75-50 Arrest Report75-507 Portable Radio Control Log75-508 Vehicle Inspection75-50B Arrest Report - Intoxication Only75-50C Arrest Report75-517 Trip Ticket - Headquarters Pool Car75-519 Prostitution and Assignation Arrests75-520 Comparative Vice Report by Divisions75-521 Vice Statistics75-522 Vice Statistics - Disposition75-523 Horseshoeing Job Order75-524 Batch Control Ticket75-526 Unit Case Folder75-53 Hearing Disposition Report75-531 Police Application Acceptance Report75-532 Data Processing Job Order75-534 Police Application Rejection Report75-535 Daily Roster Garage Personnel75-539 Notice of Impounded Auto75-540 P.C.I.C. Vehicle / Scofflaw Inquires75-541 U.T.S. & C. Carton Numbers Inventory75-542 Latent Impression Card75-544 Batch Control Log75-545

75-548 Vehicle Maintenance Log - Foreman's Work Sheet

75-551 Accident Report Statement75-552 Evidence Receiving Log - Laboratory Division75-553

75-556 Transmittal of Arraignment Information75-558 Vehicle Accident Case Record Envelope75-559 Police Garage Parts Requisition75-560 Traffic Accident Coding Sheet75-561 Citizen Complaint Report - English75-561-Ar Citizen Complaint Report - Arabic75-561-Ca Citizen Complaint Report - Cambodian75-561-Ch Citizen Complaint Report - Chinese (Traditional)75-561-Ko Citizen Complaint Report - Korean

Report of Refusal to Submit to Chemical Test to Determine Intoxication

Receipt of Charges and Acknowledgement of Right to CounselReceipt of Notice of Hearing and Second Notice of Right to Counsel

Age, Sex, Race of Persons Arrested (under 18 years of age)

Transmittal List - Notice to Remove Abandoned M.V.

75-561-Ru Citizen Complaint Report - Russian75-561-Sp Citizen Complaint Report - Spanish75-561-Vi Citizen Complaint Report - Vietnamese75-563 Special Prisoner Flow Chart - CCTV75-564 Information Sheet / Flow Chart - CCTV75-567 Philadelphia Police Tape Identification Label75-568 Daily Evaluation Report75-569 Monthly Evaluation Report75-570 Electronic Surveillance Wire Intercept75-571 Missing Person Affidavit Verification - English75-571-Ar Missing Person Affidavit Verification - Arabic75-571-Ca Missing Person Affidavit Verification - Cambodian

75-571-Ch

75-571-Ko Missing Person Affidavit Verification - Korean75-571-Ru Missing Person Affidavit Verification - Russian75-571-Sp Missing Person Affidavit Verification - Spanish75-571-Vi Missing Person Affidavit Verification - Vietnamese

75-572 Affidavit of Probable Cause for Arrest Warrant75-574 Horse Record75-576 Daily Vehicle Accident Transmittal (75-48 / AA-45)

75-578 Training Material Receipt / Record75-579 Complaints Against Police Log75-580

75-581

75-582 Prisoner Flow Chart75-583 Vehicle Examination75-584 Paid Service Request75-585 Standard Police Consent to Search Card75-586 Child Abuse Information Report75-589 Complaint Fact Record75-590 Request Computer Transmission of Court Notices

75-591 Sex Crime Unit Case Folder75-592 Application for Press Credentials75-593 Application for a License to Carry Firearms75-594 Incoming / Outgoing Call Summary75-595 Surveillance Report75-596 Daily D.N.R. Review75-597 Specific Number Summary75-598 Victim Assistance Information75-599 License Holder Questionnaire75-601 Medical Clearance Report75-602 Juvenile Information Sheet / Flow Chart75-603 Incident Information75-604 Reimbursable Imprest Voucher

Missing Person Affidavit Verification - Chinese (Traditional)

Request of Police Board of Inquiry Hearing TranscriptPolice Evidence Custodian Check Payment Release Voucher

75-605 Detainee's Medical Checklist75-606 Three Platoon Vacation Spread Sheet (One Page)

75-606A

75-608 Annual Vacation Directory75-609 Annual Vacation Request (Annually)75-610 Vacation Tally Sheet75-611 Radio Memorandum75-612 Criminal History Record75-613 False Burglary / Robbery Alarm Notification75-614 Search Warrant Information - English75-614-Ar Search Warrant Information - Arabic75-614-Ca Search Warrant Information - Cambodian75-614-Ch Search Warrant Information - Chinese (Traditional)

75-614-Ko Search Warrant Information - Korean75-614-Ru Search Warrant Information - Russian75-614-Sp

75-614-Vi Search Warrant Information - Vietnamese75-616 Crime Scene Information75-617 Flashlight Control Log75-618 Towed Vehicle Notice - English75-618-Ar Towed Vehicle Notice - Arabic75-618-Ca Towed Vehicle Notice - Cambodian75-618-Ch Towed Vehicle Notice - Chinese (Traditional)75-618-Ko Towed Vehicle Notice - Korean75-618-Ru Towed Vehicle Notice - Russian75-618-Sp Towed Vehicle Notice - Spanish75-618-Vi Towed Vehicle Notice - Vietnamese75-619 Philadelphia Police Department Warning - English

75-619-Ar Philadelphia Police Departmetn Warning - Arabic

75-619-Ca

75-619-Ch

75-619-Ko Philadelphia Police Departmetn Warning - Korean

75-619-Ru

75-619-Sp

75-619-Vi

75-620

75-621 Waiver of Liability Agreement75-622 Request for Legal Assistance

Three Platoon Vacation Spread Sheet (continuation page)

Tarjeta De Informacion Orden De Busqueda - Spanish

Philadelphia Police Departmetn Warning - CambodianPhiladelphia Police Departmetn Warning - Chinese (Traditional)

Philadelphia Police Departmetn Warning - RussianPhiladelphia Police Departmetn Warning - SpanishPhiladelphia Police Departmetn Warning - VietnameseNotice of Duty Restrictions & Reclamation of on Duty Service Weapon

75-623 Use of Force Report75-624

75-625 Consent to Search - English75-625-Ar Consent To Search - Arabic75-625-Ca Consent To Search - Cambodian75-625-Ch Consent To Search - Chinese (Traditional)75-625-Ko Consent To Search - Korean75-625-Ru Consent To Search - Russian75-625-Sp Consent To Serach - Spanish75-625-Vi Consent To Search - Vietnamese75-626 Career Development Transfer Request75-627 Counseling Form75-632

75-632-Ar

75-632-Ca

75-632-Ch

75-632-Ko

75-632-Ru

75-632-Sp

75-632-Vi

75-633 Premise History - Language Application - English

75-633-Ar Premise History - Language Application - Arabic

75-633-Ca

75-633-Ch

75-633-Ko Premise History - Language Application - Korean

75-633-Ru Premise History - Language Application - Russian

75-633-Sp Premise History - Language Application - Spanish

75-633-Vi

75-65 Firearm License Application - Follow-Up Record75-65A License to Carry Firearm75-67 Daily Complaint Summary75-7 Towing Report - English75-7-Ar Towing Report - Arabic75-7-Ca Towing Report - Cambodian

Request for Cost Anaylisis and Description of Services

Premise History - ADA (Disability) Application - EnglishPremise History - ADA (Disability) Application - ArabicPremise History - ADA (Disability) Application - CambodianPremise History - ADA (Disability) Application - Chinese (Traditional)Premise History - ADA (Disability) Application - KoreanPremise History - ADA (Disability) Application - RussianPremise History - ADA (Disability) Application - SpanishPremise History - ADA (Disability) Application - Vietnamese

Premise History - Language Application - CambodianPremise History - Language Application - Chinese (Traditional)

Premise History - Language Application - Vietnamese

75-7-Ch Towing Report - Chinese (Traditional)75-7-Ko Towing Report - Korean75-7-Ru Towing Report - Russian75-7-Sp Towing Report - Spanish75-7-Vi Towing Report - Vietnamese75-71 Vehicle Theft Report75-71A Vehicle Theft Report - Worksheet75-74A Missing Person report Work Sheet75-8 Police / Civilian Board Inquiry75-80 Morgue Fingerprint Card, Right75-80A Morgue Fingerprint Card, Left75-82 Juvenile Contact Report75-95 Code Enforcement Warning - English75-95-Ar Code Enforcement Warning - Arabic75-95-Ca Code Enforcement Warning - Cambodian75-95-Ch

75-95-Ko Code Enforcement Warning - Korean75-95-Ru Code Enforcement Warning - Russian75-95-Sp Code Enforcement Warning - Spanish75-95-Vi Code Enforcement Warning - Vietnamese75-Dir. 7-Ar Directive 7, Form #1 - Consent To Search - Arabic

75-Dir. 7-Ca

75-Dir. 7-Ch

75-Dir. 7-Ko

75-Dir. 7-Ru

75-Dir. 7-Sp

75-Dir. 7-Vi

75-DL-26-Ca

75-DL-26-Po

75-DL-26-Sp

75-DL-26-Uk

75-DL-26-Vi

75-Misc.-10 Composer's Index Card75-Misc.-11 Numerical Index75-Misc.-12 Classified Index75-Misc.-13 Notice of Intention to Abandon Automobile75-Misc.-14 Agreement (Command Level Discipline)75-Misc.-3 Standard Police Interrogation Card - English

Code Enforcement Warning - Chinese (Traditional)

Directive 7, Form #1 - Consent To Search - CambodianDirective 7, Form #1 - Consent To Search - Chinese (Traditional)Directive 7, Form #1 - Consent To Search - KoreanDirective 7, Form #1 - Consent To Search - RussianDirective 7, Form #1 - Consent To Search - SpanishDirective 7, Form #1 - Consent To Search - VietnameseArticle 1547 Warning Regarding Chemical Analysis - CambodianArticle 1547 Warning Regarding Chemical Analysis - PolishArticle 1547 Warning Regarding Chemical Analysis - SpanishArticle 1547 Warning Regarding Chemical Analysis - UkrainianArticle 1547 Warning Regarding Chemical Analysis - Vietnamese

75-Misc.-3-Ar Standard Police Interrogation Card - Arabic75-Misc.-3-Ca Standard Police Interrogation Card - Cambodian75-Misc.-3-Ch

75-Misc.-3-Ko Standard Police Interrogation Card - Korean75-Misc.-3-Ru Standard Police Interrogation Card - Russian75-Misc.-3-Sp Standard Police Interrogation Card - Spanish75-Misc.-3-Vi Standard Police Interrogation Card - Vietnamese

75-Misc.-4

75-Misc.-4-Ar

75-Misc.-4-Ca

75-Misc.-4-Ch

75-Misc.-4-Ko

75-Misc.-4-Ru

75-Misc.-4-Sp

75-Misc.-4-Vi

75-Misc.-5

75-Misc.-5-Ar

75-Misc.-5-Ca

75-Misc.-5-Ch

75-Misc.-5-Ko

75-Misc.-5-Ru

75-Misc.-5-Sp

75-Misc.-5-Vi

75-Misc.-6

75-Misc.-6-Ar

75-Misc.-6-Ca

75-Misc.-6-Ch

75-Misc.-6-Ko

Standard Police Interrogation Card - Chinese (Traditional)

Domestic Abuse and Violence Notice of Rights - English & SpanishDomestic Abuse and Violence Notice of Rights - ArabicDomestic Abuse and Violence Notice of Rights - CambodianDomestic Abuse and Violence Notice of Rights - Chinese (Traditional)Domestic Abuse and Violence Notice of Rights - KoreanDomestic Abuse and Violence Notice of Rights - RussianDomestic Abuse and Violence Notice of Rights - SpanishDomestic Abuse and Violence Notice of Rights - RussianSidewalk Behavior Ordinance 10-611 Written Warning Card - English & SpanishSidewalk Behavior Ordinance 10-611 Written Warning Card - ArabicSidewalk Behavior Ordinance 10-611 Written Warning Card - CambodianSidewalk Behavior Ordinance 10-611 Written Warning Card - Chinese (Tradiditonal)Sidewalk Behavior Ordinance 10-611 Written Warning Card - KoreanSidewalk Behavior Ordinance 10-611 Written Warning Card - RussianSidewalk Behavior Ordinance 10-611 Written Warning Card - SpanishSidewalk Behavior Ordinance 10-611 Written Warning Card - VietnameseInformation Card requesting Consent to a Police Interview - EnglishInformation Card requesting Consent to a Police Interview - ArabicInformation Card requesting Consent to a Police Interview - CambodianInformation Card requesting Consent to a Police Interview - Chinese (Traditional)Information Card requesting Consent to a Police Interview - Korean

75-Misc.-6-Ru

75-Misc.-6-Sp

75-Misc.-6-Vi

75-Misc.-7 Commander's Checklist75-Misc.-8 Lieutenant's Sergeant's Emergency Check List75-Misc.-9 Tenant's Referral Notice - English75-Misc.-9-Ar Tenant's Referral Notice - Arabic75-Misc.-9-Ca Tenant's Referral Notice - Cambodian75-Misc.-9-Ch Tenant's Referral Notice - Chinese (Traditional)75-Misc.-9-Ko Tenant's Referral Notice - Korean75-Misc.-9-Ru Tenant's Referral Notice - Russian75-Misc.-9-Sp Tenant's Referral Notice - Spanish75-Misc.-9-Vi Tenant's Referral Notice - Vietnamese75-S-196 Fingerprint Chart

Warnings To Be Given By Police - Cambodian

Warnings To Be Given By Police - Polish

Warnings To Be Given By Police - Russian

Warnings To Be Given By Police - Spanish

Warnings To Be Given By Police - Ukrainian

Warnings To Be Given By Police - Vietnamese

77-Misc.-Vi Tenant's Referral Notice - Vietnamese

ADDITIONAL FORMS:

Information Card requesting Consent to a Police Interview - RussianInformation Card requesting Consent to a Police Interview - SpanishInformation Card requesting Consent to a Police Interview - Vietnamese

75-WarningsToBeGivenByPolice-Ca75-WarningsToBeGivenByPolice-Po75-WarningsToBeGivenByPolice-Ru75-WarningsToBeGivenByPolice-Sp75-WarningsToBeGivenByPolice-Uk75-WarningsToBeGivenByPolice-Vi

Form Number Form Name Active/Defunct Internal

If "Active" is selected, the form is still being used by the City. Defunct forms are outdated or no longer used.

If "Yes" is selected, this form is stored electronically and indexed.

If "Yes" is selected, the form information can be filled out and submitted via a computer system.

External Electronic Automated

Review the list of forms below and fill out all information in the white areas as completely as possible. If there are any forms for your department that are NOT listed, please add those forms to the "Additional Forms" section in the bottom in this spreadsheet. Please do NOT create your own spreadsheet or

External Electronic Automated