Form Center

2. Name*
3. Email Address*
5. Address of Incident*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
13. Are You the Occupant or Owner*

    1. Yes
    2. No
14. Are You an Insurance Company?*

    1. Yes
    2. No

    Please check if you are an insurance company requesting a copy of the fire report for a fire incident resulting in a loss. 

16. Involvement*

    If you are not the owner, please state the reason for the request:

    
    

18. Fire Incident Location/Address*
20. Date/Time for Requested Incident*
    Date/Time for Requested Incident

    Date/Time for Requested Incident
21. Open Records Request

    If you are submitting an Open Records Request in accordance with the Georgia Law, please submit your request on agency/department letter head.

23. Type of Incident*

    1. Structure Fire
    2. Vehicle Fire
    3. Auto Accident
    4. Medical Incident
    5. Other

    
    

    
    

Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field