Information on this form will assist the Shakopee Fire Department in providing the records you are requesting. You need to provide sufficient information to specifically identify records, such as case number, incident location, and/or the date of occurrence, otherwise we may not be able to locate the records. Under Minnesota law, some information not subject to release may be removed or redacted.

1

Requester's Information

 *

Requester's Information

First

Middle initial

Last Name

2

Address

 *

Address

Street

City

State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip code

3

Phone

Phoneext.

4

Email

Email

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5

Records Requested

 *

Records Requested

Incident/Case Report Number (if known)

Type of incident

Date of incident

Time of incident

Location of incident

Involved persons

Description of records requested

6

Requester is the subject of the data (Must show valid picture ID as proof of identity)

 *

Requester is the subject of the data (Must show valid picture ID as proof of identity)

Yes

No

Fire Department Reports are $20
Please make check/money order payable to the "CITY OF SHAKOPEE" and mail or deliver payment to:

Shakopee Fire Department
2700 Vierling Drive E.
Shakopee, MN 55379

Fee Schedule available at www.ShakopeeMN.gov/fees

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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