Fire & Police Advocates

Information Update Form

If you have been appointed as the fire or police advocate for your department and your up to date information has not been submitted to the Citizens Commission for the Safety and Care of the Elderly please download this form, print/mail or email it to:

Chief Richard Susi, ret, at rifirechiefs@gmail.com

Department or District Name: __________________________________________

Advocate Name: _____________________________________________________

Advocate Contact information:

Email address: __________________________________

Business phone: _________________________________

Cell phone: _____________________________________

Other phone: ____________________________________

For verification purposes, please provide the name and contact information of the chief, supervisor or person responsible for appointing you an elderly advocate:

Name________________________________________Phone___________________