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Request for Service 1 o f 1 PPD FRM -205 PLAINFIELD POLICE DEPARTMENT 14300 S. COIL PLUS DR. PLAINFIELD, IL 60544 (815) 436-6544 Fax: (815) 436-1486 REQUEST FOR SERVICE PLEASE PRINT DATE OF REQUEST: YOUR NAME: YOUR ADDRESS: YOUR CITY, STATE, ZIP CODE: DO YOU WANT TO BE CONTACTED? (PLEASE CIRCLE) YES NO PHONE NUMBER: ALTERNATE PHONE NUMBER: DAMAGE / REPAIR REQUEST WHAT IS DAMAGED? (PLEASE CIRCLE) SIGN LIGHTPOLE TRAFFIC LIGHT GRAFFITTI OTHER :__________________________________________________________ LOCATION: DESCRIPTION OF DAMAGE: YOUR COMMENTS: NEIGHBORHOOD PROBLEM NATURE OF PROBLEM: LOCATION: PEOPLE INVOLVED: NAME: ADDRESS: PHONE NUMBER: NAME: ADDRESS: PHONE NUMBER: NAME: ADDRESS: PHONE NUMBER: YOUR COMMENTS: OTHER PROBLEM NATURE OF PROBLEM: POLICE DEPARTMENT USE ONLY RECEIVED BY: DATE: ASSIGNED TO: DATE: POLICE DEPARTMENT COMMENTS: COMPLETED BY: DATE: 1 2 3 Record your non-traffic related request for service on the form below. Please provide as many details as possible. You may FAX this form to 815-436-1486, or you may also drop this form off at the Plainfield Police Department, Monday–Friday from 8a.m. until 6 p.m.