Request for a Fire Report

2. Date of Incident:*
   Date of Incident:

3. Location of Incident:

5. Type of Incident:*
   -- Select One --Motor Vehicle AccidentStructure FireMedical

7. First Name of Requestor

8. Last Name of Requestor

10. Address To Mail Report To:

12. City

13. State

14. Zip

16. Email Address:

18. Under Florida law, e-mail addresses are public records. If you do not want your email address released in response to a public records request, do not send electronic communications to this entity. Instead, contact the City of Ormond Beach Fire Department by phone at 386-676-3255, or in writing.

Leave This Blank:


20. Submit

* indicates a required field