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Request for Fire Incident Report
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Franklin County Department of Public Safety • 1488 Franklin Street • Rocky Mount, VA 24151 • 540-483-3091
Property Owners may request a fire incident report free of charge. Please complete this form and submit.
ALL OTHERS: The cost is $10.00. Please bring or mail your payment to the above address and make check payable to Franklin County Department of Public Safety.
Company Name (if applicable)
Phone Number where you can be reached
Date of Incident
Date of Incident
Address of Incident
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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