St Matthews Fire Runs & Open Records Request Form

St Matthews Fire Runs & Open Records Request Form
THIS FORM IS NOT FOR REQUESTING PROTECTED HEALTHCARE INFORMATION.

Those requests need to be made with the proper signed HIPAA compliant paperwork through our business office.
Requester Name *

First Name Last Name
Business/Organization Name (If Applicable)
Are You a Media Organization *

Yes No
Please Provide Us With a Means to Contact You

We must have a way to contact you (email preferred, for expediency), should responsive records become available.
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Extension
Fax

Area Code Phone Number
Records Sought

Providing as much information as possible will allow us to respond most efficiently.
Is this request for an environmental study? *

Yes No
Type a question *

911 Call/Fire Report Fire Inspection Report or Letter Permit Other
If 911 Call/Fire Report, please tell us response date and location

Month Day Year
Date
Response Location

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Records Time frame From

Month Day Year
Date
To

Month Day Year
Date
Other Time Frame
Describe the specific record or records you wish to examine here or submit attachment with record description below: *
Attach a File

Browse Files

Cancel of
Mailing Address

St Matthews Fire & Rescue

240 Sears Ave.

Louisville, Ky 40207
Should be Empty:

THIS FORM IS NOT FOR REQUESTING PROTECTED HEALTHCARE INFORMATION.