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GRAMA Request Form

2. First Name*

3. Last Name*

5. Mailing Address*

7. Physical Address *

9. City *

10. State*

11. Zip*

13. Email*

14. Phone*

16. Subject

18. Case / Incident Number

20. Reports Requesting

    1. Police Report
    2. Jail Records

22. Description - To include, subjects involved, where incident took place, date of incident, the nature of requested incident. *

    Please be specific in your description of the requested records.

24. Signature *

25. Date *

Leave This Blank:


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

    This field is not part of the form submission.

29. Submit

* indicates a required field