Get Ma Le100 (formerly 20385) 2017

The MA LE100 form, formerly known as 20385, is essential for submitting a request for immediate threat license suspension or revocation. This guide provides clear and comprehensive steps to assist users in completing this form online.

Follow the steps to successfully complete the MA LE100 form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the date of request in the specified field at the top of the form. Ensure it is in the correct format.
3. Document the date of the incident. This is crucial for establishing the timeline of events.
4. Fill in the incident location, specifying the city and state where the incident occurred.
5. Provide the operator’s full name and license number. This identifies the individual in question.
6. Complete the address and date of birth fields for the operator, along with the associated city and state.
7. In the provided space, summarize the incident or circumstance that raised concern regarding public safety.
8. If the request is related to a medical incident, check the box provided to denote this connection.
9. Sign and date the form. The printed name serves as an electronic signature for the police chief or authorized person.
10. Additionally, the officer must print their name and position before signing.
11. Check the box confirming that all necessary supporting documentation has been attached.
12. Upon completing the form, save your changes. You can also download, print, or share the document as needed.

Complete the MA LE100 form online today for a swift submission process.