Fire Department Incident Report Request

2. Fire Reports
   - Must have Photo ID - Be Owner or Occupant - Or Insurance Agent

   - Must have Photo ID - Be Owner or Occupant - Or Insurance Agent

4. EMS Reports
   - Must have Photo ID - Be the Patient - Or have, in writing, permission from patient

   - Must have Photo ID - Be the Patient - Or have, in writing, permission from patient

8. Requestor Information

10. Date*
    Date

12. First Name*

14. Last Name*

16. Address*

18. Email*

20. Phone Number

24. Incident Information

26. Date of Incident*
    Date of Incident

28. Location of Incident*

30. Type of Incident*

    1. Fire
    2. EMS
    3. Other

32. If other please specify

34. Any other information here

Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field