Aldine Fire & Rescue/ Harris County ESD No. 24
Administration Phone: 281-951-3700

 OPEN RECORDS REQUEST

                         

Online Request Form

    Requestor's Full Name (Required):

    Requestor's Relationship (Required):

    Name(s) of Involved Party (Required):

    Insurance Company/ Attorney Name (If Applicable):

    Mailing Address (Required):

    E-mail Address (Required):

    Phone Number (Required):

    Incident Type (Required):

    Description of Information Requested (Required):

    Approximate Date Range of Incident (Required):

    Approximate Time of Incident (Required):

    Preferred Delivery Method (Required):

    Does your Request include and Affidavit to be completed? (Required):

    Include the delivery email address if different than above:

    Requestor Signature (Required):

    Request Date (Required):

    Below, you may attach supporting documents with your request, such as: Driver’s License or ID (for involved parties), Letter of Representation (for attorneys or insurers), Claim Number or Policy Info (for insurance companies), Release Authorization (HIPAA related)