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Department of Public Safety Incident Report Request

Please note: If you do not have a SUID number, please enter a "0" in the SUID number field.
The form will not submit if that field is empty.

Date (mm/dd/yy)

Full Name

SUID Number

E-Mail Address
Cell Phone Number

Case Number Requested (DR Number)

Reason for Request

Any other identifying information about your incident:


Department of Public Safety
005 Sims Hall, Phone: 443-2224/Fax: 443-2930

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