Coleman-Baker Act Request

Requestor Information

Name of Requestor

First

Last

Requestor Relationship to Victim (required)

Email Address (required)

Telephone Number (required)

Address

Street address (required)

City (required)

State (required)

Zip code (required)

Victim Name

First

Last

Date of Death (Approximate) (required)

Place of Death (required)

Date of Birth

What agency initially investigated this death?

GBI Case Number

If a Coleman-Baker Act application has been submitted, other than to the GBI, when was it submitted and to what agency?