Luzerne County 9-1-1 - Compliments Form

2. First Name

3. Last Name

5. Physical Address

   This should include your numeric and street address, followed by City, Boro or Township (Ex. 123 Main St., Fairmount Twp)

7. Phone Number

8. Return email

   Please put in your return email here

9. Date & Time of Incident
   Date & Time of Incident

   Date & Time of Incident

   Please put in the date and time of the incident in question

11. Compliment of the 9-1-1 center in detail:
    Please detail your compliment to the 9-1-1 center in this box

    Please detail your compliment to the 9-1-1 center in this box

Leave This Blank:


13. 1. Receive an email copy of this form.
14. Email address

    This field is not part of the form submission.

15. Submit Submit and Print

* indicates a required field