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IOWA PEACE OFFICER MEMORIAL
OFFICIAL SUBMISSION FORMS

| IPOM Main Page | Criteria for Inclusion | Application for Inclusion |
| Iowa Line of Duty Death Listing | National Law Enforcement Officer Memorial |

The Iowa Peace Officer Application for Inclusion Form is to be completed by an Official representative of the officer's department and must be signed by the Agency Head or his/her designee or this form will NOT be processed.

The deadline for submission of the Iowa Peace Officer Memorial Application For Inclusion Form is December 31st of each year for inclusion on the Iowa Peace Officer Memorial the following year.

We cannot accept emailed forms as they require official signatures. Please either Fax or mail them to us.

	Click here if you are a Law Enforcement Agency to download the printable.rtf format form.
	Click here if you are a Law Enforcement Agency to download the .pdf format form. (You must have Acrobat Reader)
	Click here if you are not a Law Enforcement Agency to submit the Iowa Peace Officer Memorial Notification Form in printable .rtf format form. The Iowa Department of Public Safety will contact the officer's department for completion of the Iowa Peace Officer Memorial Application For Inclusion Form.
	Click here if you are not a Law Enforcement Agency to submit the Iowa Peace Officer Memorial Notification Form in printable .pdf format form (You must have Acrobat Reader). The Iowa Department of Public Safety will contact the officer's department for completion of the Iowa Peace Officer Memorial Application For Inclusion Form.

FAX THE COMPLETED FORM TO:

Iowa Department of Public Safety
Public Information Bureau
(515) 725-6195

OR MAIL TO:

Iowa Department of Public Safety
Public Information Bureau/Iowa Peace Officer Memorial
215 East 7th Street
Des Moines, Iowa 50319