2. The following application requests the Athens Clarke County Police Department to conduct a review of a Cold Case Murder pursuant to State of Georgia Official Code: 17-21-3, also known as the “Coleman-Baker Act”.

4. Applicant (Your) Information
6. First Name*
7. Last Name*
9. Address 1*
11. Address 2
13. City*
14. State*
15. Zip*
17. Phone Number (Mobile)
19. Phone Number (Home)
21. E-mail
23. Applicant Designation

    'Immediate family member' means a parent, parent-in-law, grandparent, grandparent-in-law, sibling, spouse, child, or stepchild of a victim or any person who exercised in loco parentis control over a victim under the age of 18 years. 

     ‘Designated person' means an immediate family member or their designated legal representative who shall be a member in good standing with the Georgia State Bar.

24. Select Your Desigination*
    -- Select One --Parent/Legal GuardianParent-in-lawGrandparentGrandparent-in-lawSiblingSpouseChildStepchildDesignated Legal Representative (List Family Member Being Represented)
26. If Attorney, list the name of the Immediate Family Member you represent
28. Case Information

    Please enter as much information as possible.

30. Deceased's First Name*
31. Deceased's Last Name*
33. Date of Death
    Date of Death
34. Incident Location
36. Law Enforcement Case Number
37. Date of previous case review, if any.

39. Upon review of this completed application by the Criminal Investigation Division, the applicant will receive written notice the application has been received.  This written notice will advise the applicant if their application has been accepted or denied.  

    If the application is denied, the applicant will receive the reason(s) for the denial in writing.  This denial will also provide contact information for the Criminal Investigation Division representative, along with contact information for the Office of Professional Standards.

    If the application is accepted, this written notice will include the contact information for the Detective(s) conducting the review along with the contact information for the Office of Professional Standards.

41. Attestation *

    1. This application is made in accordance with Official Code of Georgia Annotated (O.C.G.A) 17-21-1. By signing this application requesting a Cold Case review, the applicant attests the information listed within is accurate and truthful to the best of their knowledge.
43. Type Your Electronic Signature*
44. Date*
    Date
46. This Section to be Completed by ACCPD

    Application Received By:

    Date:

    Application Reviewed By:

    Date:

    Application is   ACCEPTED    /    DENIED

    Notification Sent By:

    Date:

Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field