2. Date of Request*
4. 
   
6. Report Type*

   1. Crime Report
   2. Traffic Collision Report
   3. Call for Service
8. First and Last Name of Requestor*
10. Agency/Company Name
12. Email Address of Requestor
14. 
    
16. Address*
18. City*
19. State*
21. Phone Number*
23. 
    
25. Report Number (if known)
26. Deputy's Name (if known)
28. 
    
30. Date / Time / Location of Incident
32. Date / Time Reported (if different)
34. Complete Name of Involved Parties
36. Vehicle Information (if applicable)
38. Briefly Describe Incident*
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40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit Submit and Print

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