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Please call 1-800-635-6840 for processing of this request. 911 EXIGENT CmCUM8TANCES FORM To Cingular Wireless National Subpoena Compliance Center phone 1-800-635-6840 Fax 1-888-938-4715 From Re Iowa City Police Department Name of AgencylPSAP Emergency Request for Records for Wireless Number This office received a 911 distress call for assistance from the above telephone on. 200 at - a*m*/p*m* Duration of call min sec* Based upon that phone call we believe that one or more people face immediate danger of death or serious physical injury. As such we request that you promptly provide us with the following inf nnation so that we may render assistance to that individual or individuals current subscriber and billing infonnation for the above-referenced telephone and/or cell site or location illfomlation for the call placed by the above-referenced telephone to 911. Signature Printed Name Title Address City Sate Zip 410 E Washington St* Iowa City IA 52240 Contact Number 319-356-5279 Contact Facsimile ---------------------- Date This form must be filled out in it s entirety. Fax completed form to NSCC at 888 938-4715. - 265 - THIRD PARTY 911 EXIGENT CIRCUMSTANCES FORM Cingular National Compliance Center Agency Name Agency Number a third party who received a distress call from the above telephone on date 200 at. a*m*/p*m*. Based upon that phone call our PSAP Iowa City Police Department believes that one or more people face immediate danger of death or serious physical injury. As such we request that you promptly provide us with the following infonnation so that we may render assistance to that individual or individuals - 266 -. 200 at - a*m*/p*m* Duration of call min sec* Based upon that phone call we believe that one or more people face immediate danger of death or serious physical injury. As such we request that you promptly provide us with the following inf nnation so that we may render assistance to that individual or individuals current subscriber and billing infonnation for the above-referenced telephone and/or cell site or location illfomlation for the call placed by the above-referenced telephone to 911. As such we request that you promptly provide us with the following inf nnation so that we may render assistance to that individual or individuals current subscriber and billing infonnation for the above-referenced telephone and/or cell site or location illfomlation for the call placed by the above-referenced telephone to 911. Signature Printed Name Title Address City Sate Zip 410 E Washington St* Iowa City IA 52240 Contact Number 319-356-5279 Contact Facsimile ---------------------- Date This form must be filled out in it s entirety. Signature Printed Name Title Address City Sate Zip 410 E Washington St* Iowa City IA 52240 Contact Number 319-356-5279 Contact Facsimile ---------------------- Date This form must be filled out in it s entirety. Fax completed form to NSCC at 888 938-4715. - 265 - THIRD PARTY 911 EXIGENT CIRCUMSTANCES FORM Cingular National Compliance Center Agency Name Agency Number a third party who received a distress call from the above telephone on date 200 at.

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