Incident Information Request Form

Incident Information Request Form 1. What was the original offense charge? 2. What is the plea agreement charge? 3. Incident date:

4. Time of incident: 5. Incident location: 6. Responding police department 7. Name of police officer or deputy sheriff 8. Incident summary (please give a brief description of the incident)

9. List any weapons involved in the incident. 10. If a firearm please enter type (long gun or handgun) caliber, make and model.

11. Duration of probation (please enter months) 12. Date Probation ends: 13. Court Case Number: 14. Probation Officer Information • Probation Officer Name: • Probation Officer phone number: • Probation Officer E Mail Address: • Officer Court Location Number: 15. Probation training program completion date: