2. Today's Date:
4. Requesting Firm or Individual:*
6. E-mail:
8. City:*
10. Address:*
11. ST:*
12. Zip:*
14. Telephone Number:*
16. Is this part of a pending criminal investigation or matter?*

    1. Yes
    2. No
18. Agency or Agencies involved

    1. Bismarck Police Department
    2. Burleigh County Sheriff's Department
    3. Mandan Police Department
    4. Bismarck Fire Department

    1. Bismarck Rural Fire Department
    2. Mandan Fire Department
    3. Metro Area Ambulance Service
19. This Agency's Case Number or Event Number
21. Type of Incident:*
23. Date(s) Occurred:*
25. Time(s) Occurred:*
27. Location of Incident:*
29. By checking the yes box, you are authorizing staff from the Combined Communications Center to contact you at the telephone number you have provided if additional information is required to locate your request.

    1. Yes
    2. No
31. Miscellaneous Information/Description:
33. 
    When the request is completed, you will be contacted to pick up the records. Payment is required at the time of pick up.

    Please make checks payable to the "Central Dakota Communications Center". We do not accept payment by credit card.
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit Submit and Print

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