Incident Report Request Form
York County Department of Fire and Life Safety
I hereby request a copy of the following report:
Fire/Rescue
Date and time of Incident:
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Name of Owner/Occupant/Patient:
Location of Incident:
Name of Individual Requesting:
First Name
Last Name
Company/Agency (if any):
Signature of Individual Requesting:
Date of Request:
-
Month
-
Day
Year
Date
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Should be Empty: