[RIDE ALONG REQUEST} Arfian Anugrah

[Arfian Anugrah]

RIDE ALONG REQUEST

1. PERSONAL INFORMATION

• 1.1 FULL NAME

• • FIRST NAME: Arfian
    MIDDLE NAME: -
    LAST NAME: Anugrah

2. DATE OF BIRTH

• • DOB (DD/MM/YYYY): 25/01/2002
    Nationality: Indonesian
    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,

[ARFIAN ANUGRAH]