top of page

Memorial Rose Request

 

Please use this online form as a request for assistance from Backing the Blue Line. We will review the request and respond according to our Standard Operating Procedures. If this is urgent, please feel free to contact us via email.

​

Any information you do not know, please put "Do Not Know" or "N/A".  If you have any questions, comments or concerns, please contact Family Support Director or Fallen Officer Memorial Rose Director.

​

Fallen Officer Memorial Rose Request Form

Status of the LEO or K9:
Did the death happen in the line of duty?
Yes
No

Please list their relationship to the LEO/BtBL member: (Jane Doe/Wife, Jane Doe/Daughter or John Doe/Husband, etc.

What is the surviving family's/handler's address?

Please list a departmental contact, family friend or family member we could contact for further information, if needed, as well as how to contact them.

Please indicate what type of contact they are, for example: Family Friend, Chief of Officer, Sheriff of Deputy, or Wife of Officer, etc.

Please be as specific as possible... Include names, dates and anything else that will help us give them the best support and care we can. (Who, what, when, where, how, etc.)

By submitting this form, you are granting the following permission to email you.

 

Backing the Blue Line: Police Wives of Minnesota

7900 International Drive, Suite 300
Bloomington, MN 55425
bottom of page