LIGHTHORSE POLICE DEPARTMENT
The Chickasaw Nation
1130 West Main
Ada, Oklahoma 74820
BILL ANOATUBBY
GOVERNOR
MICHAEL MANNING
CHIEF OF POLICE
Police Report Request Form
Requested By:
Agency/Reporting Party:
Reason Requesting Party Seeks LPD Reports: _
______________________________________________________________________________
Mailing Address:
Email Address:
Phone #:
Fax #:
Case #:
Preferred Method of Release:
Under penalty of perjury, I affirm that the above information is true and correct to the best of my
knowledge.
Signed:______________________________________________
Date: _______________________________________________
The information to be released must accompany this form.
Please submit via email, fax or mail to lighthorsepolicerecords@chickasaw.net or 580-310-6457 or
1130 W. Main, Ada, OK 74820
Office use only:
Received by: _______________________ Date:__________________________
Information sent via:_________________ Date sent:______________________
Form no. 08022PRR IS-LPD 7/2018
