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February 2006
Request for Use of Closed-Circuit Equipment
Request closed-circuit equipment by completing this form and submitting by mail or FAX to:

Virginia Department of State Police
Bureau of Criminal Investigations
Criminal Intelligence Division
P.O. Box 27472
Richmond, Virginia 23261
Phone: (804)
674-2669 FAX: (804) 674-2934

Person Requesting Equipment

Name ____________________________________
Title __________________________________
Address ___________________________________________________________________________
__________________________________________________________________________________
Phone ____________________________________
Fax __________________________________
Signature
(required)
___________________________________________________________________

Case Information

Locality/Jurisdiction ___________________________ Date of Offense _______________________
Name of Case State vs. ______________________________________________________________

Has a Motion been filed to use closed-circuit testimony?
Has it been approved?

Yes
No



Yes
No

Date __________ (please attach copy of the motion)

Type of court hearing (check all that apply)

Preliminary
Hearing
Date/Time
______________
Jury Trial
Date /Time ______________
Bench Trial
Date /Time ______________
Civil Child Protection
Date /Time ______________

Installation Information

Note: Installation of equipment takes approximately 2 hours. Please provide the following information
to aid in the installation process.
Location of the Courthouse _____________________________________________________________
Courtroom Location or Room number_____________________________________________________
When will court room be available for installation? __________________________________________
Local contact person regarding scheduling and installation of equipment
Name_____________________________________ Agency _______________________________
Phone ____________________________________
Fax __________________________________

Direct questions about this service, cancellations, or rescheduling requests to:
Assistant Special Agent-in-Charge Virginia State Police Technical Unit
(804) 323-2027