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2. This form is not intended for emergency reporting. If you are reporting an emergency or need police, fire or emergency medical response, please call 911. Use of this form is for convenience only and does not constitute official notice to the City of Bremerton. Please note that responses are subject to disclosure under the Public Records Act per RCW 42.56.
4. Date and Time*
   Date and Time

   Date and Time
5. Frequency *

   How often is this event happening?

   1. One time
   2. Random

   1. Continual
7. Location*
   Please be as specific as possible.
9. Vehicle Description
11. Make
12. Model
13. Color
14. License Plate Number
16. Issue*
18. If follow-up is requested, please provide contact information.
20. Name
21. Email Address
22. Telephone Number
24. If you have additional related items to report please use our Bremerton 1 Customer Response Line.
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field