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2. PUBLIC RECORDS REQUEST FORM
4. Date of Request (Today's Date)*
   Date of Request (Today's Date)
6. First Name (Optional)
7. Last Name (Optional)
9. Address (Optional)
11. Email Address*
13. City (Optional)
14. State (Optional)
15. Zip (Optional)
17. Be as specific with your request as possible so that we can fulfill it. If you have details such as the report number, location, date of incident, or type of incident please include it. Thank you.
19. Report Number
20. Date of Incident
    Date of Incident

    Date of Incident
22. Incident Location
24. Type of Incident
26. Other Information
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field