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2. First Name*
3. Last Name*
5. Address1*
7. City*
8. State
9. Zip
11. Phone Number*
12. Date of Birth*
13. Type of Incident
15. Location of Incident*
19. TO THE FRASER DEPARTMENT OF PUBLIC SAFETY,
    I HEREBY REQUEST COPY/COPIES OF PUBLIC RECORDS, AS FOLLOWS
20. Incident Number
22. Number of Copies*
    -- Select One --12
23. Description of Public Record*
25. Check as it applies below

    1. Please provide a copy of the requested records
    2. Please allow me the opportunity to inspect the requested public records prior to copying. Note: You will be charged for labor even if you do not want a copy of the documents
27. MAILING OPTION: (PLEASE CHECK ONE BELOW)
29. Check as it applies below

    1. Call me at the number above so I can pick the documents up.
    2. Mail the documents to me. You will be charged for postage, payment must be received first.
    3. Email the response to me if possible @______________________(payment must be received first)Fax the results to me at _______________ (payment must be received first)
33. PAYMENT: (PLEASE CHECK ONE)

    1. I understand that the public body will charge me a fee for copying, searching, reviewing, mailing, separating and deleting exempt material.
    2. Attached is an affidavit of indigence. Please furnish the records without charge for the first $20.00 of the required fees.
35. I understand the the Freedom of Information Act requires the public body to have a response in 5 business days, but may request an extension of 10 additional days if needed the Fraser Department of Publc Safety shall, no later than fifteen (15) business days from the date your request was received, either (1) grant your request, or (2) grant your request in part and issue a written denial of part of your request.
37. Signature of Person making the request
39. Do you agree?
    By clicking "I agree" you agree and aknowledge that 1) your application will not be signed in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your "electronic signature" is valid and binding upon you in the same force and effect as the handwritten signature. 3) You will be the person picking up the records, with proper photo identification, unless other arrangments have been made.
41. Check below

    1. I agree
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit Submit and Print

* indicates a required field