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2. Please provide as much information as possible.
4. Requestor's Name
5. Requestor's Phone Number
7. Requestor's Email
9. Information about Request
11. Date of Incident
    Date of Incident
12. Location of Incident (Use Street Address - in Durant)
14. Type of Incident and Description
16. Person(s) Involved
18. Type of Request

    1. Motor Vehicle Collision Report
    2. Offense Report
    3. Dispatch Log Sheet
    4. 911 Call
    5. Radio Traffic
20. Additional Comments
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit Submit and Print

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