Police/Fire/EMS 9-1-1 Request Form

PD/FD/EMS 9-1-1 Request Form
Police DepartmentFire Company
Police Agency:
Fire/EMS Agency:
Name:*
Email:*
example@example.com
Contact Number:*
Format: (000) 000-0000.
Event Date and Time:*

MonthDayYear

12 Hour Format AM/PM Option
Event Location:*
Township:*
County Event #:
Nature of Event:*
Copy of Event History911 Phone Call (LAW ENFORCEMENT ONLY) (retention is only for 5 months prior to event date)Radio Transmissions
Statement for Release of Recordings:
Example statement: We are requesting permission from DES to release copies of (incident #), all phone calls, regarding (brief description of call) which occurred at (location of event) on (date of event) for (reason for request).
Comments:
Should be Empty:

PD/FD/EMS 9-1-1 Request Form