General Crime Information & Complaint Form

2. Please include as much information as possible in the form. Incomplete or inaccurate information will delay processing of this report and may compromise our ability to quickly and effectively respond to this complaint. Thank you.

4. 1. Please tell us where the problem is

6. Address*

   The address must be entered correctly for the report to be processed, a misspelled or incomplete entry will return a negative response.

8. City*

9. State*

10. Zip Code*

12. 2. Please select where the activity occurs at the location given in section 1

14. Identify the activity location for this violation*

    1. Alley or Driveway
    2. Garage
    3. Hallway / Corridor
    4. Inside Business
    5. Inside Private Residence
    6. Other Activity Location
    7. Park / Wooded Area
    8. Sidewalk / Street Corner
    9. Vacant Lot
    10. Vehicle

15. If "Other" is selected, please specify

17. 3. Please tell us about the security at this location

    Help us determine what we're up against so we can take the necessary precautions. If you don't know, please leave this section blank.

    Help us determine what we're up against so we can take the necessary precautions. If you don't know, please leave this section blank.

19. Have you seen guns at this location?

    1. Yes
    2. No

20. Are there dogs at this location?

    1. Yes
    2. No

22. 4. Please tell us about the activity

24. Activity Nature*

    1. Cocaine
    2. Heroin
    3. Marijuana
    4. Other

25. If "Other" is selected, please specify

27. Days when activity is present*

    Select all that apply, do not exaggerate - we will be using this information to verify the report

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
    7. Sunday
28. Times when activity is present*
    Times when activity is present Start Time

    —

    Times when activity is present End Time

30. Describe the activity*

    Use this area to tell us about the activity being reported. Explain as much in detail about the situation as you can. Remember, you can't tell us too much!

32. 5. Please tell us about the offender

    If you know the drug dealer's name, description, current address or phone number, please provide it.

    If you know the drug dealer's name, description, current address or phone number, please provide it.

34. Offender's Name

35. Offender's Nickname

37. Offender's Age

    Enter the approximate age of the primary age of the Offender at this location. You may enter an age range. Example: 20-25 years

38. Offender's Race and Sex

40. Offender's Phone Number

41. Offender's Pager Number

43. Offender's Address

45. City

46. State

47. Zip Code

49. Offender's Description

    Please describe the violator's appearance. Include scars, tattoos, clothes, jewelry descriptions, hair styles and any other distinguishing marks. If you can't provide a description enter "Unknown" in this space.

51. 6. Please tell us about any vehicle used by the participants

    Use this area to tell us about any vehicles used by the participants of this activity.

    Use this area to tell us about any vehicles used by the participants of this activity.

53. Vehicle Type
    -- Select One --CarOtherTruck

54. Vehicle Year

    An approximate year is acceptable, if it's a newer car please mention that.

56. Vehicle Manufacturer

    For example, Ford, Chevrolet, Honda, Cadillac

57. Vehicle Model Name

    For example, Escort, Camaro, Civic, El Dorado

59. Vehicle Color

60. License Plate State

    If you don't know the state, please describe the color.

62. License Number

    If you only know part of it, please enter it.

64. Unique Features

    Describe any unique features like damaged parts, accessories, sun roofs, etc. The idea is to give us a unique description of the car so we can immediately recognize it.

66. 7. Please tell us about yourself

    This area is completely optional. You do not have to provide this information to us. If you decide to, we will use it only to contact you for additional information. This information will be kept strictly confidential.

    This area is completely optional. You do not have to provide this information to us. If you decide to, we will use it only to contact you for additional information. This information will be kept strictly confidential.

68. First Name

69. Last Name

71. Address

73. City

74. State

75. Zip Code

77. Daytime Phone

78. May we call you for additional information?

    1. Yes
    2. No

80. Email Address

82. Additional Comments

Leave This Blank:


83. 1. Receive an email copy of this form.
84. Email address

    This field is not part of the form submission.

85. Submit

* indicates a required field