SB 111: Officer-Involved Use of Deadly Force Resulting in Death Reporting Form

Reporting Law Enforcement Agency * = required
Name:*
Title:
Agency:
Phone:
Address:
Fax:
State:
Email:
Incident * = required
  1. Last:
    First:
    Middle:
  2. (MM/DD/YYYY HH:MM PM)
  3. Agency Name:
    Agency ORI:
  4. Address:
    City:
    State:
    Zip:
  5. (MM/DD/YYYY)
Notes