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Citizen Incident Report

  1. * indicates required field

  2. Please further identify time of incident:*

  3. Was First-Aid Given?*

  4. Was Medical Emergency Treatment Given?*

  5. Village of Lombard
    ATTN: Village Manager's Office
    255 E. Wilson Ave.
    Lombard, IL 60148.

  6. Leave This Blank:

  7. This field is not part of the form submission.