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2. Name of Requestor*
4. Company (if applicable)
6. Street Address*
8. City*
9. State
10. Zip
12. Daytime Phone Number*
14. Email*
15. Fax
17. Request is for:*

    1. Copies of Records

    1. Inspection of Records
19. Are the public records requested for a commercial purpose?*

    1. No

    1. Yes
21. Type of Incident
22. Location of Incident
24. Name of Person(s) Involved
26. Date of Incident
27. Report Number (if known)
29. Please describe below the public records you are requesting. Please be as specific as possible, omissions could result in processing delays.
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34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field