Chowchilla Police Report Request Form Page 2
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2Chowchilla Police Department
Jay A. Varney, Chief of Police
122 Trinity Avenue, Chowchilla, California 93610
POLICE REPORT REQUEST FORM
PLEASE PRINT LEGIBLY
Requestor’s Name:
________________________________________________________________
Address:
________________________________________________________________
Home Phone: ________________ Work Phone: _______________________
( ) Please Mail Report ( ) Call Me When Report Is Ready For Pick-Up
REPORT INFORMATION
(Please complete as much as possible)
Report #: _______________ ( ) Traffic Accident ( ) Other: ______________
Location of Incident:
________________________________________________________________
Date and Time of Incident:
________________________________________________________________
Names/Birthdates of Persons Involved:
________________________________________________________________
________________________________________________________________
________________________________________________________________
- - - - - - - - - - - - - - - - - - - - - - -Do Not Write Below This Line - - - - - - - - - - - - - --
Date Received: _______________ Received by: __________________
Processed By: _____________ Date Notified: __________________
Service & Safety
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Office (559) 665-8600 Fax (559) 665-7416
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Parent category: Business