Logan Police Request for Report Form

Date of Request: MM/DD/YY
Requestor Name  
First Name:
Last Name:
Telephone Number:
E-mail Address:
Fax Number:
(If Fax # not provided, report will be left at station for pickup)  
Location of Incident  
Street Name:
Date of Incident: MM/DD/YY
Approximate Time of Incident:
Officer  
Name of Investigating Officer:
Type of Report: Accident: Offense:
Give us the name that will be on the report:
Was this subject a Victim Complainant Driver Passenger
  Pedestrian Bicyclist