[REQUEST RIDE-ALONG PROGRAM] Thomas Saepuloh

[Thomas Saepuloh]

RIDE ALONG REQUEST

1. PERSONAL INFORMATION

• 1.1 FULL NAME

• • FIRST NAME: Thomas
    MIDDLE NAME:
    LAST NAME: Saepuloh

2. DATE OF BIRTH

• • DOB (DD/MM/YYYY): 11/02/1998
    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
[Thomas Saepuloh]