Ride Along Request - M. Lele Jupriyanto

[M Lele Jupriyanto]

RIDE ALONG REQUEST

1. PERSONAL INFORMATION

• 1.1 FULL NAME

• • FIRST NAME: Mas
    MIDDLE NAME: Lele
    LAST NAME: Jupriyanto

2. DATE OF BIRTH

• • DOB(DD/MM/YYYY): 10/02/2000
    Nationality: Indonesia Gender: MALE

By signing this document, I acknowledge that the opportunity to participate in the Los Santos
Police Department Ride-Along Program is a privilege and that the assigned officer, Chief of
Police, or his designee can discontinue my participation in the ride-along program at any
time.

Sincerely yours,

M. Lele Jupriyanto