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VACATION EXTRA PATROL REQUEST
FIRST NAME
LAST NAME
ADDRESS
CONTACT PHONE
NAME OF CONTACT
DATE LEAVING (MM/DD/YYYY)
TIME LEAVIING (HH:MM AM or PM)
DATE RETURNING (MM/DD/YYYY)
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ANY OTHER INFORMATION YOU FEEL IS IMPORTANT
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Prairie Grove Police Department • 151 E. Buchanan • Prairie Grove, AR 72753 • (479)846-3270
