[Request Ride Along LSSD] Sumardono Khan

[Sumardono Khan]

RIDE ALONG REQUEST

1. PERSONAL INFORMATION

• 1.1 FULL NAME

• • FIRST NAME: Sumardono
    MIDDLE NAME: Khan
    LAST NAME: -

2. DATE OF BIRTH

• • DOB (DD/MM/YYYY): 05/04/2000
    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 deputy, Sheriff, or his designee can discontinue my participation in the ride-along program at any
time.

Sincerely yours,
your signature
[Sumardono Khan]