Florida Advisory Committee on Arson Prevention, Inc.

Application for General Reward - Law Enforcement Use Only

Please complete all items as fully as possible. Use reverse side if needed.

 

1. A. Inv./Requestor’s Name: _______________________________________

B. Title & Agency: _____________________________________________

C. Address: _________________________________________________

D. Phone: ________________ Email:___________________________

E. Case #: ____________________ ( ) BFAI ( ) SAO ( ) CCR

2. Location of Fire: ________________________________________________

3. Date of Fire:____________________________________________________

4. Owner of Property: ______________________________________________

Address if Different: _____________________________________________

5. Insurance Carrier Name: __________________________________________

Address:_______________________________________________________

Contact Person & Phone: _________________________________________

6. Estimated Damages: _____________________________________________

  1. Suspect(s): _____________________________________________________
  2. Requestor/Recipient (if different): ___________________________________

    Note: This information may be discoverable in any criminal or civil trial. FACAP will issue payment to the person or agency named in this blank. If the identity of the person supplying the information is given (informant), FACAP will return this form without payment or consideration of the Application for General Reward.

  3. Summarize Reason for Reward request. Include what information was given, why it was given and what value to the investigation it provided, was conviction made: __________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
  4. Results / Status of Case: ____________________________________________________ ________________________________________________________________________

Signed:________________________________________________ Dated: __________________

 

Send To: FACAP Rewards Committee
C/O Gerald T. Albrecht, Chairman, FACAP Rewards Committee; One Harbour Place, 777 South Harbour Island Blvd., Suite 500, Tampa, FL 33602 Telephone: (813)281-1900; Fax: (813)281-0900
e-mail: galbrecht@butlerpappas.com .

FACAP Rewards Program Records Retention Policy – No records concerning a reward request will be retained by FACAP once the request is acted upon, either by payment or denial or request.