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2. Name*

   First and Last Name of the Person Making Fire Report Request

3. Email Address*
5. Phone Number*
6. Date of Incident*
   Date of Incident

   Date of Incident
7. Type of Request*

   1. Fire Run Report/Insurance
   2. Fire Investigation Report
9. Description of Request (Please include as much information as possible in your request such as dates, times, names, location etc. so that we may expedite your request as soon as possible):
11. Attachments
    If you have any supplemental information you would like to provide as a part of this request (i.e. letters, emails, etc.) please add them below:
13. How Do You Want To Receive Your Report?*

    1. Email
    2. Mail

    There is a $5.00 fee for all reports whether digital or print. At this time, payments must be made via check or cash. 

    Payments can be made:

    1. In person at Fire Station 1 (40 W Broadway St, Shelbyville, IN 46176) 
    2. Via mail to:  Gena Denk  c/o Fire Report Request 40 W Broadway St, Shelbyville, IN 46176
15. Mailing

    If you have requested to receive your report via mail, please provide the correct mailing address below.

17. Address
19. City
20. State
21. Zip Code
Leave This Blank:


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

    This field is not part of the form submission.

25. Submit

* indicates a required field