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2. I Have an Attorney*

   1. Yes
   2. No
4. I request a copy of my police report be mailed to me. If you have an attorney, the report will be mailed to your attorney.
6. Name*
8. Address*
10. Citation Number*
12. Electronic Signature Agreement

    I understand that if I obtain an attorney I will give the attorney my copy of the police report.

    1. I agree.
14. Date
    Date
15. Electronic Signature
17. Mail Request to:

    City Attorney's Office
    118 W Maple Street
    P.O. Box 609
    Centralia WA 98531

Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field