Request for Release of Records

Type of Record (required)

Fire Incident Report

Other

If other, please specify

Incident Information

Date of Incident

Address/Incident Location

Incident #

Requestor Information

Name/Company (required)

Address Line 1 (required)

Address Line 2

City (required)

State (required)

Zip (required)

Phone (required)

Email (required)

Requestor's Relationship to Incident/Request (required)

Reason for Request (required)

To be released via: (* A fee may be assessed for printed copies) (required)

Pickup

US Mail (using address noted above)

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

I agree to use electronic records and signatures

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