WILDFIRE REPORT
Department of Natural Resources / Division of Forestry
State Form 50296 (7-01)
1. 2. 3. 4. 5. 6.
Date _____________________________ Reporting Fire Department _____________________________________________ Department NIFRS Number (Example: 55-015)
Address _______________________________________________________________ City State Zip_________
County____________________________________________
7. Name of Landowner where fire started **************************************************************************** 8. Cause of Fire (Check one) 9. Type of fuel burned (Acres) Lightning _ Hardwoods _______ Campfire Pine Forest _______ Smoking Pasture/Field _______ Debris Burning Crops _______ Arson Strip Mines _______ Equipment Right-of-way _______ Railroads Children Total Acres _______ **************************************************************************** 10. 11. 12. 13. No fires reported for month of ___________________________________________ Signature of person making report ________________________________________ Title of person making report ________________________________________
Check here if you need more forms _______ Fire Control Headquarters 6220 Forest Road Martinsville, IN 46151 (765) 342-4701 (765) 342-4760 Crystal M. Hunt, Program Coordinator Fire Control Headquarters [email protected]
Mail Reports to:
Any questions please contact: