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2. Please provide your contact information.
4. First Name*
5. Last Name*
7. Email Address*
8. Phone Number*
10. Address1*
12. Address2
14. City*
15. State
16. Zip*
18. Please describe the records being requested:*

    1. Offense or incident report

    1. Accident report

    1. Other
20. Location of offense / incident or accident:
21. Date of offense / incident or accident:
    Date of offense / incident or accident:
22. Case number of offense / incident or accident:
24. Other information:
26. How do you prefer we contact you regarding your request?

    1. Phone

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

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30. Submit

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