Coleman-Baker Act Request

2. Requestor Information
4. First Name*
5. Last Name*
7. Requestor Relationship to Victim*
   -- Select One --ChildGrandparentGrandparent-in-lawParentParent-in-lawSiblingSpouseStepchildExercised in loco parentis control over a victim under the age of 18Designated attorney with the State Bar of Georgia (retained by one of the above classifications of persons)
9. E-Mail Address*
10. Telephone Number*
12. Address*
14. City*
15. State*
16. Zip Code*
20. Victim Information
22. Victim First Name*
23. Victim Last Name*
25. Date of Death (approximate)*
26. Date of Birth
28. What agency initially investigated this death?
30. Fayetteville Police Case Number
32. Please provide a detailed explanation of why you believe this case should be reinvestigated. Include any new information, leads, or suspicious circumstances that may have come to your attention.
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field