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2. Offender's name
3. Possible aliases / nicknames
5. Offender's address or location of the offense
7. Sex
   -- Select One --MaleFemale
9. Automobile Information: Year
11. Automobile Information: Make
13. Automobile Information: Model
15. Automobile Information: License Plate
17. Be specific in describing the criminal activity/public safety issue*
19. What date did the criminal activity occur?
    What date did the criminal activity occur?
21. What time did the criminal activity occur?
    What time did the criminal activity occur?
23. Additional information or comments
25. Check this box if you would like to be contacted

    1. Contact me
    2. No
27. Full Name
28. E-mail address
30. Phone number
31. Upload a file

    Files must be less than 2 MB.

    Allowed file types: gif jpg jpeg png txt rtf pdf doc docx xls xlsx avi mov mp3 ogg wav.

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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field