Records Request Form

Records Request Form
Requesters Name

First NameLast Name
Requesters Email Address
example@example.com
Requesters Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Requesters Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relation to Report (i.e. patient, homeowner, law firm)

Requester Type

Date of Incident

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name of Involved Party

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Incident Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Report Requested
How would you like to receive the records?
Photo ID of Requester

Cancelof

Date of Incident

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name of Involved Party

First NameLast Name
Incident Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Requesting Organization
Type of Report Requested
How would you like to receive the records?
Upload Records Request and Custodian Affidavit Here

Cancelof

Date of Incident

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name of Involved Party

First NameLast Name
Incident Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Requesting Organization Name
Type of Report Requested
How would you like to receive the records?
Upload Records Request and Custodian Affidavit Here

Cancelof

How would you like to receive the records?
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Requester Email Address
example@example.com
Fax Number
Please enter a valid phone number.Format: (000) 000-0000.
Type of Record
Date Range of Records
Detailed Description of Records Being Requested

My Products
prevnext( X )
Patient/Personal/Public Document Records Request Fee
Free Quantity



Legal Records Request Fee
$15.00 Quantity



Investigation Records Request Fee
$40.00 Quantity



Total

$0.00
Other Payment Option
If you prefer to pay by check, please make all checks payable to Truckee Fire Protection District. Checks can either be mailed to PO Box 2768, Truckee CA 96160, or delivered to Station 91 located at 10049 Donner Pass Rd. Truckee, CA 96161.

***Records will be released once payment is received***
Acknowledgement

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty: