Please provide the following contact information about yourself:
Please identify the individuals involved in the incident.
Note: Please identify, to the best of your ability, what role the
person played in the incident using the drop down menu, labeled
Enter the date/time and location of the incident:
Time (hh:mm - am/pm):
Location of Incident (Address):
may contact me regarding this matter.
Voluntary Statement: Please describe the circumstances of
the incident. Please be as specific as possible, not leaving out any
detail. Tip: It is easier to describe a situation by
using the Who, What, Where, When, Why, and How format.
141 W Elm
Wichita, KS 67203
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