Seekonk Police Department

 Town of Seekonk

                  500 Taunton Avenue

               Seekonk, Massachusetts 02771

        Chief of Police                                                                                     Telephone - (508)336-8123 

        RonaldCharron                                                                                     Fax No. (508)336-0850

 REPORT REQUEST    (M.G.L.  C66, S10)

MASSACHUSETTS LAW ALLOWS TEN (10) DAYS TO FILL SUCH REQUEST.  ALL WILL BE MAILED AS SOON AS POSSIBLE.    IF ANY PROBLEMS DEVELOP, WE WILL CONTACT YOU BY PHONE.

BASIC FEES:             M/V ACCIDENT REPORT:    $5.00

                                 ALL OTHER INCIDENT REPORTS:    $3.00

CHECKS MUST BE MADE OUT TO:        TOWN OF SEEKONK

DATE OF REQUEST: _________________________CASE NUMBER: __________________________

       ADDRESS REPORT IS TO BE MAILED TO: ____________________________________________

                                                            NAME: ____________________________________________

                                                            STREET: ____________________________________________

                                                               CITY: ____________________________________________

                                                             STATE: ________________ZIP CODE: __________________

                                                          PHONE: ____________________________________________

TYPE OF REPORT REQUESTED: ________________________________________________________

NAME OF SUBJECT INVOLVED: ______________________________________________________

DATE OF OCCURRENCE: ____________________________________________________________

LOCATION OF OCCURRENCE: _______________________________________________________

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DO NOT WRITE BELOW LINE

DEPARTMENT USE ONLY

               REPORT NUMBER: _________________________________________________

                              MAILED: _________________________________________________

                                       BY: _________________________________________________

     INVOICE NUMBER/FEE: _________________________________________________