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Douglas County Sheriff's Office
Citizen Report Form

Return to Filing a Report 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.

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