Required fields are marked with asterisks (*)

Fire Incident Report Request Form

Complete this LaSalle Fire Service form to request a fire incident report. A fee of $80.00 (HST incl.) per incident must accompany all requests for Fire Incident Reports.

*Please note that a 1.75% service charge will be applied to the credit card you use and will appear on your statement as a separate transaction.

Please provide incident information below.

Date of incident

Incident Number (If Known)

Street Name or Location/Intersection of Incident

Requester of a copy of a Fire Report

Solicitor

Insurance Company

Property Owner

Other

If other, please specify.

Specify Request Information:

Please provide contact information below.

Contact Name

Address

Postal Code

Email Address

Primary Phone Number

Signature

Clear

LaSalle Fire Service

1900 Normandy Street,

LaSalle Ontario N9H 1P8

Phone: (519) 966-0744

Fax: (519) 966-9346

Privacy Statement: Personal Information contained on this form is collected pursuant to the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purpose of responding to your request. Questions about the collection of this information should be directed to the Fire Chief, Town of LaSalle Fire Service, 1900 Normandy St., LaSalle, ON, N9H 1P8. Telephone: 519-966-0744.