Emergency Disclosure Request Form*

Here is a sample emergency disclosure form adapted from Facebook Law Enforcement Guidelines 2013.

EMERGENCY DISCLOSURE FORM
Pursuant to 18 U.S.c. § 2702 (b) (7) and § 2702 © and the Facebook privacy policy, Facebook may exercise its discretion in providing relevant data after reviewing the provided information below. Please provide as much information in order to enable the Security team to conduct an appropriate search.

1. Describe the nature of the emergency (i.e. potential bodily harm, crime being committed):

2. Provide the identification of all users involved (Facebook user profile name, ID number, and Date of Birth):

3. Provide the exact location(s) of the evidence related to the described emergency:

I, [Officers Name], attest that the above-mentioned facts are true and accurate to the best of my knowledge.

________________________ ________________
Officers Signature & Badge # Date and Time