Citizen Report Form

Administration - Emergency Management - Divisions - Community Services - Support Services - Odds 'n Ends

Douglas County Sheriff's Office
Citizen Report Form

If you need to report an emergency, call 911.

Today's Date
Current Time
Date(s) Crime/Incident Occurred
Time(s) Crime/Incident Occurred

CRIME / INCIDENT INFORMATION
Briefly describe the crime / incident in the box below

ADDRESS WHERE CRIME OCCURRED If crime did not occur at a specific address, list the block or nearest street intersection here
Address #		Street
City		State
Zip Code		Type of Location
PERSONAL INFORMATION
Last Name		First Name
Middle Name		Email Address
Sex		Race (optional)
Date Of Birth (mm/dd/yy)
YOUR ADDRESS
Address #		Street
City		State
Zip Code
YOUR PHONE NUMBERS
Home Phone		Work Phone
YOUR VEHICLE INFORMATION (if applicable)
Vehicle License #		State
Year		Make
Model		Body Style
Colors (top/bottom)

STOLEN AND / OR DAMAGED PROPERTY
S=Stolen D=Damaged	How Many	Item	Brand	Model/Style	Serial #	Color	Engravings/ Peculiarities	Value

By checking this box, the person making this report understands that knowingly making or transmitting a false report to a law enforcement agency is a criminal offense.

Authentication:
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Douglas County Sheriff's Office Citizen Report Form

Douglas County Sheriff's Office
Citizen Report Form