Fire Report Request

2. Requestor Name*

3. Agency Name (if applicable)

5. Mailing Address*

7. Phone Number

8. Fax Number

9. Email

11. Preferred Method of Contact*
    -- Select One --EmailU.S. MailFaxIn Person

15. Location / Address of Fire*

17. City*
    -- Select One --EugeneSpringfield

19. Date of Fire
    Date of Fire

20. Estimated Date of Fire

    If the actual date of the fire is unknown, please provide an approximate date.

22. Type of Report Requested*

    1. Basic Incident Report
    2. Investigation Report
    3. Photo Disc

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