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2. Name (Optional)
3. Email Address (Optional)
5. Phone Number (Optional)
7. What time of crime occurred?*

   1. Drugs
   2. Theft
   3. Fraud
   4. Assault
   5. None
   6. Other(Give Detail in Comments box below)
9. Comments
11. Date and Time of Criminal Activity*
    Date and Time of Criminal Activity

    Date and Time of Criminal Activity
13. Suspect's Name and/or Description*
15. How the crime is/was being committed and any other detail to provide: *
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17. 1. Receive an email copy of this form.
18. Email address

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19. Submit

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