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2. This form is exclusively intended for use by local law enforcement, Fire/Rescue, and EMS personnel.

   Fire/Rescue/EMS personnel may occasionally necessitate additional support from local law enforcement or specialized equipment owing to the recurring nature of certain calls. In such cases, Law Enforcement may request the inclusion of officer safety information alongside other pertinent responder details. This form serves as a mechanism for first responders to petition for automatic assistance during specific incidents. 

   Kindly complete all sections of this form thoroughly.

   Should you require any clarification or assistance, please do not hesitate to contact Mrs. Morlock, the Audio & Data Entry Clerk, 410-535-1600 ext. 2342 or Records Supervisor Mrs. Denton at ext.2352.

6. Requesting Agency:*
7. Requester Name and Title:*
9. Requester Phone Number:*
10. Requester Email Address:*
14. Persons Name for Alert
15. Date of Birth
17. Alert Address*
19. City*
20. State*
21. Zip*
22. Apt/Suite#
24. Response Requested: (Submit One)*

    1. Police
    2. Engine/EMS
    3. Misc.
26. Remarks/Reasoning:*
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field