THE CITY OF PEORIA FIRE DEPARTMENT
REQUEST FOR FIRE INCIDENT REPORT
Request for Public Records (A.R.S. Title 39)
 
Incident Reports are provided free of charge to any individual(s) involved in the incident.  Others may purchase the records at a cost of $10.00 per report if request is made within the first 30 days after the incident, $20.00 per report if request is made 30 or more days post incident.  
 
Medical records will be released only to the person who has been treated by the Peoria Fire Department or legal guardian if the person is a minor.  All third party requests require signed written authorization which is compliant with HIPAA regulations.
 
NAME:___________________________________________________________________________
 
STREET:__________________________________________________________________________
 
CITY: _____________________________________STATE: _____________ ZIP: _______________
 
TELEPHONE: ________________________________ FAX: _________________________________
 
Incident Number: __________________________ Date of Incident: ____________________________
 
Address of Incident ___________________________________________________________________
 
Type of Incident: _____________________________________________________________________
 
Report(s) to be: * Mailed __________                         Picked-up _________

Please return this form along with your payment to:                     
PEORIA FIRE DEPARTMENT          
ATTN: INCIDENT REPORTS CLERK                                                                                                                         
8351 W. CINNABAR AVE                                                                 
PEORIA, AZ  85345
Checks must be made payable to the “CITY OF PEORIA.”

* Documents can be mailed if a stamped self-addressed envelope is sent with this form.                                  
 
PLEASE NOTE: Public records are in various locations within the City.  The City requests that a reasonable amount of time be expected for responding to any request to copy or inspect City records.  The City may require additional time to process more difficult requests and if so, an estimated time frame will be provided to the requestor.  
                                                                                                             
                                                                                                                                                
 Signature ______________________________________________________________ Date_________________