Coleman-Baker Act Request Form

Fields marked are required.

First Name

Last Name

Requestor Relationship to Victim

If other, please enter:

Email Address

Phone Number

Street Address

Apt / Suite / Other

City

State

Zipcode

First Name

Last Name

Date of Birth

Date of Death (Approximate)

Place of Death

What agency initially investigated this death?

GCPD Case Number

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