| Online
Crime Report |
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| STEP
1: Time
and Location of the Crime: |
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| Type
of Offense |
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| Date(s)
of Offense |
Occurred
From:
(mm/dd/yyyy)
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Occurred
To:
(mm/dd/yyyy)
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| Time
Offense Occurred |
Occurred
From:
(ex. 12:00AM)
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Occurred
To:
(ex. 1:00AM)
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| Address
or Location
of Crime |
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| Name
of business or landmark, if known |
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Email
Address of Victim |
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| An
email address is required whether the victim is a person or business. If
no email exists, please enter "No Email". The form will not be
submitted without an entry into this field. |
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| STEP
2: If
the Victim is a BUSINESS,
please complete the following fields: |
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| Business
Name |
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| Business
Address |
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| Business
Phone |
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| STEP
3: If
the Victim is a PERSON,
please complete the following fields: |
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| Full
Name
of Victim |
First
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Middle
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Last
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| Address
of Victim |
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| Zip
Code of Victim |
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| Home
Phone of Victim |
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| Alternate
Phone |
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| Age
of Victim |
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| Date
of Birth of Victim |
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| Victim's
Employer |
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| Victim's
Employer's Address |
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| Victim's
Work Phone |
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| Gender
of Victim
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Race
of Victim
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| Ethnicity of Victim |
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| STEP
4: If
you are NOT the victim, please complete the following fields: |
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| Relationship
to Victim |
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| Your
Full
Name |
First
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Middle
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Last
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| Your
Full Address |
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| Your
Phone Number |
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| Your
Email Address |
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| Your
Date of Birth |
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| Your
Age |
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| Your
Gender |
Male
Female
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| Your
Race |
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Your Ethnicity
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Hispanic
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Non-Hispanic
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| STEP
5: Description
of the Crime: |
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| Please
be Specific when describing the details of the crime you are reporting. |
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| STEP
6: Complete
this section for (L)
Lost (S)
Stolen or (D)
Damaged property: |
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| STEP
7: If
a vehicle was involved in any way, you MUST complete the following
section: |
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| How
was Vehicle Involved? |
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| Vehicle
License Number |
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| State
of License Plate |
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| Vehicle
Make |
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(Ford,
Chevrolet, Dodge, Toyota, etc.) |
| Vehicle
Model |
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(Ranger,
Camero, Stealth, Camry etc.) |
| Vehicle
Type |
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(Pickup,
Van, Convertible, 4dr. etc) |
| Vehicle
Year |
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| Vehicle
Identification Number (VIN) |
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(The VIN can be
found on the dash board or driver-side door of the vehicle or on the
title or registration forms) |
| Vehicle
Color(s) |
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| Comments |
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| STEP
8: Submit Form or Reset Form |
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Pursuant to ARS 13-2901.01,
it is unlawful for a person to knowingly make to a law enforcement
agency of either this state or a political subdivision of this state a
false, fraudulent, or unfounded report or statement or to knowingly
misrepresent a fact for the purpose of interfering with the orderly
operation of a law enforcement agency or misleading a peace officer. |
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