Fallen Firefighter Registry

The purpose of this online reporting application is to track the deaths of firefighters lost in the line of duty and
outside the line of duty. This would include those firefighters who have retired, or are no longer active.

Fields denoted in red are required.

First Name: Last Name:

MI:

Gender: Age:

City: County:

Department: Rank:

Employment Type: Employment Status:

Date of Death: Service Years:

Line of Duty Death:

Yes

No

Brief Bio (500 character maximum)

Cause of Death (300 character maximum)

Survivors (300 character maximum)

Submitted By:

First Name: Last Name:

MI: Email: