E-911 Records Request

2. Date Submitted*
   Date Submitted

4. Name*

5. Email Address*

7. Address*

9. City*

10. State*

11. Zip Code*

13. Phone Number*

15. Date of Incident*
    Date of Incident

16. Approximate Time*
    Approximate Time Start Time

    —

    Approximate Time End Time

    Please provide an approximate time frame of incident occurrence.

17. Type of Record Requested*
    -- Select One --Copy of 911 CallCopy of Dispatch NotesCopy of 911 Call & Dispatch Notes

19. Incident Description*

    Please provide an address and details involving this particular incident; including but not limited to location, what occurred and parties involved.

21. Terms and Conditions for Open Record Requests
    Please acknowledge the terms and conditions required: I understand that, pursuant to O.C.G.A.§ 50-18-71, I may be charged administrative and copying fees for the cost to search, retrieve, copy and supervise access to the requested documents. This fee represents the hourly rate of the lowest paid full-time employee with the necessary skill and training to respond to my request, with no charge for the first thirty minutes that it takes to respond to the request. The charge for copies is generally $.10 per page unless otherwise provided by law. I agree to pay all copying and/or administrative costs incurred with fulfilling my open records request.

    Please acknowledge the terms and conditions required: I understand that, pursuant to O.C.G.A.§ 50-18-71, I may be charged administrative and copying fees for the cost to search, retrieve, copy and supervise access to the requested documents. This fee represents the hourly rate of the lowest paid full-time employee with the necessary skill and training to respond to my request, with no charge for the first thirty minutes that it takes to respond to the request. The charge for copies is generally $.10 per page unless otherwise provided by law. I agree to pay all copying and/or administrative costs incurred with fulfilling my open records request.

23. Acknowledgement *

    1. I understand and agree to pay any fees related to this request.

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

    This field is not part of the form submission.

26. Submit

* indicates a required field