2. 
3. Select One*

   1. Media
   2. General Public
5. Email Address*
6. Purpose of Request*

   1. Personal
   2. Commercial
   3. Public Interest
10. Information Requested:*
12. First Name
13. Last Name*
15. Name of Person Making Request*
16. Phone Number
18. Address1*
20. City*
21. State*
22. Zip
24. Company of Requestor
25. Signature and Date*
27. Vague or open ended request will not be accepted or processed

    Any copies will be made in accordance with the fee schedule and procedure established by the Ponca City Police Department pursuant to the Oklahoma Open Records Act, 51 O.S. & 24 A. 1 et. Seq. Return form To: Ponca City Police Department, 300 E. Oklahoma Avenue Ponca City, Oklahoma 74601 Phone (580) 767-0370 Fax: (580) 767-0374 Email: Police@poncacityok.gov

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