2. 
4. DAPHNE POLICE DEPARTMENT REQUEST FOR FUNERAL ESCORT
8. FUNERAL HOME*
9. CONTACT NAME*
11. CONTACT PHONE*
12. CONTACT EMAIL*
16. REQUESTED DATE OF FUNERAL ESCORT*
17. REQUESTED TIME OF FUNERAL ESCORT*
19. START LOCATION*
20. END LOCATION*
22. Will other Police agencies be assisting?*

    1. Yes
    2. No
23. If "Yes," which one(s):
25. Approximate number of vehicles in procession:
27. Preferred route of procession:

29. It is the Daphne Police Department's policy to limit the number of vehicles in a funeral procession to 10. This does not include funeral home vehicles or Patriot Guard riders. This limitation may be removed for processions not traveling through heavy traffic areas such as US Highway 98 and/or State Highway 181.

    Upon receipt and review of your submission, a member of our department will contact you to confirm your request. Thank you.

33. APPLICANT NAME*
34. APPLICANT DATE*
    APPLICANT DATE
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field