Upper Moreland Township

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Last Added: 3/21/2017 9:55 AM

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Upper Moreland Township

Upper Moreland Township
117 Park Avenue
Willow Grove, PA19090-3215

Phone: (215) 659-3100
Email: Township Receptionist

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Confidential Narcotics Report Form

Please include as much information as possible in the form below. 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.

All fields marked with an asterisk (*) are required.

1. Please tell us where the problem is

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

*Address
Address 2 or Apartment #

2. Please select where the activity occurs at the above location

*Identify the activity location for this violation, please select only one.
Inside Business
Inside Private Residence
Alley or Driveway
Hallway/Corridor
Park/Wooded Area
Sidewalk/Street Corner
Vacant Lot
Vehicle
Garage
Other Activity Location
If "Other" is selected, please specify:

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

Have you seen guns at this location?
Yes, No
Are there dogs at this location?
Yes, No

4. Please tell us about the activity

*Activity Nature?
Complete the areas below to acquaint us with the type of drug activity you are reporting and when it occurs.
If "Other" is selected, please specify:
*Days when activity is present?
Select all that apply, do not exaggerate - we will be using this information to verify the report.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
*Times when activity is present?
Select all that apply, do not exaggerate - we will be using this information to verify the report.
12 AM - 2 AM
2 AM - 4 AM
4 AM - 6 AM
6 AM - 8 AM
8 AM - 10 AM
10 AM - Noon
Noon - 2 PM
2 PM - 4 PM
4 PM - 6 PM
6 PM - 8 PM
8 PM - 10 PM
10 PM - 12 AM
Infrequently
24 Hours a Day
Don't Know
*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!

5. Please tell us about the drug dealer or distributor

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

Dealer's Name
If you know the Dealer's name please provide it below.
Dealer's Nickname
If you know the Dealer's nickname please provide it below.
Dealer's Age
Enter the approximate age of the primary age of the Offender at this location. You may enter an age range. ie: 20-25 years.
Dealer's Race and Sex
Please enter the race and sex of the primary Offender below.
Dealer's Phone Number
If you know the primary Dealer's phone number enter it below.
Dealer's Pager Number
If you know the primary Dealer's pager number enter it below.
Dealer's Address
If you know the address of the violator enter it below.
City / State / Zip Code
If you know the Dealer's city, state and zip provide this below.
Dealer'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.

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.

Vehicle Type
Vehicle Year
An approximate year is acceptable, if it's a newer car please mention that.
Vehicle Manufacturer
For example, Ford, Chevrolet, Honda, Cadillac
Vehicle Model Name
For example, Escort, Camaro, Civic, El Dorado
Vehicle Color
License Plate State
If you don't know the state, please describe the color.
License Number
If you only know part of it, please enter it.
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.

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.

Your Name
Street Address
Address 2 or Apartment #
City & State
Zip Code
Daytime Phone
May we call you for additional information?
Yes, No
Email Address
Additional Comments

Verification (to reduce spam)

* To submit this form, please repeat the following word:

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