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State of Texas Assistance Request (STAR)(Latest Version as of 10/11)
Incident Name:Initial Request Date / Time:Requesting County / Entity:Request #:
Is this RR Tied to Another Request? (provide other Request Number)Other Tracking Numbers:
Request Item Description
Detailed Item Description:
QtyUnitItem NameCostDemob Item?
(kind, type, characteristics, brand, specs, size, etc.)
Justification / Purpose for Request:
When is this Resource Needed?Estimated Timeframe of Need (how long will you need this resource?
Delivery Information
Final Destination
Point of Contact (POC) Name:POC Telephone Number:POC Email:POC Fax:
Facility Name:Facility Telephone Number:Facility Zip:
Facility AddressFacility CityFacility State
Additional Instructions:
Requestor Information
Requested by Position (Name):Requestor Email:Requestor Phone Number:
Requestor Signature:Date / Time
Provide Map, Diagram, etc. if Available: