Report A Crime - Online Police Report Submission

Online reports can only be submitted if there are no
known suspects or evidence.

* Required Fields
Step 1: Victim Type

Is the victim of the crime that you are about to report a person or a business?
Person Business
 
Step 2: Reporting Persons Information
Name of Victim *
 Date of Birth (mm/dd/yyyy) *
Victim Address *
 Apt:
  
City *
 State

 Zip
Home Phone *
 Occupation
Work Address
 City
Work Phone
 State
 Zip
Driver's license/MVD Issued ID Card #
 State
Age
 Race
 Sex *
Male Female
Email *
 Confirm Email *
 
Step 3: Incident Information
 
Choose Incident Type *

Time Frame in which the Incident Occurred
Incident Start Date (mm/dd/yyyy) *
 Incident Start Time
:
Incident End Date (mm/dd/yyyy)
 Incident End Time
:
Information about the Property/Items Involved
Dollar Value - $
Incident Location

 City: Prescott Valley, Arizona
Description- Please be concise. Describe property lost, taken, or damage.
Description of Incident
 

Step 4: Confirm Online Police Report

  • I understand that I am filing this report for information / insurance purposes only.
  • I understand that filing this report that there are no known suspects.
  • I understand that there may not be a follow-up investigation conducted by the Prescott Valley Police Department
  • I understand that filing a false police report is a crime punishable by law.
  • I hereby certify that this report is true and correct to the best of my knowledge.

I agree to the above terms and conditions
 
Signature -
First Name, Middle Initial, Last Name
Current Date
07/30/2010

Validation * Enter this text to validate the form: police

 

 

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