2. 
4. CITY OF PUEBLO FIRE DEPARTMENT
   RECORDS REQUEST
   1551 Bonforte Blvd
   Pueblo, CO 81001
   Phone: (719) 553-2830 Fax: (719) 553-2831
   Email: cityfire@pueblo.us
6. Public Records Requests take a minimum of seventy-two (72) hours and may take several weeks dependent upon the record requested. Research fees will be assessed after the initial hour.
8. Company Name:
9. Date:*
   Date:
11. Contact Last Name*
12. Contact First Name*
14. Address1*
16. Address2
18. City*
19. State*
20. Zip*
22. Phone:*
23. Fax:
24. Email:*
26. Information Requested (Check all that apply)*

    1. 9-1-1 Incident
    2. Fire Inspection Report

    1. Hazardous Material Incident
    2. Storage Tank Information
28. 9-1-1 Call Type:
    *

    1. Fire
    2. Medical
30. Please specify any additional information needed.
32. Please specify address points and/or
    parcel numbers (if known) for the records.
      Street                                                                                 Zip*
33. 
    
    
      Street                                                                                    Zip
    
35. Date(s) or Range of dates of records Requested:
    (Available Databases: 5 years from current date)  
    From*
    Date(s) or Range of dates of records Requested:
    (Available Databases: 5 years from current date)  
    From
36. 
    
    To*
    
    
    To
40. .*

    1. I agree not to use, share, or disseminate any information pertaining to the record other than for lawful purposes.
42. Typed name indicates your electronic signature*
43. Date*
    Date
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit Submit and Print

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