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2. Request Information
4. I wish to file a(n):*

   1. Update on a case
   2. Inquiry
   3. Suggestion
   4. Other
6. You are:*

   1. Victim
   2. Complainant
   3. Other
10. Contact Information
12. First Name*
14. Last Name*
16. Date of Birth*
    Date of Birth
18. Your Driver's License/State ID (If applicable)
20. Address*
22. Street Address
24. Address Line 2
26. City*
27. State*
28. Zip Code*
30. Home Phone or Cell Phone Number*
32. Work Phone
34. Email
38. Incident Details
40. Brief Description of Incident or Request**
42. Location of Incident**
43. Date of Incident**
    Date of Incident*
45. Name of Palos Park Police Officer/Employee (If known)
    First and Last
47. Name of Witness(es) or Others Involved (If known)
    First and Last
49. Witness Address (If known)
51. Witness Phone Number (If known)
53. Statement/Description of Incident/Reason for Request/Additional Information about Case
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55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

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