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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 *
27. Fee's*

    1. I acknowledge fees are associated with GRAMA requests
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field