City of Peoria, Arizona

Online Crime Report

STEP 1: Time and Location of the Crime:

Type of Offense

Date(s) of Offense

Occurred From: (mm/dd/yyyy)

Occurred To: (mm/dd/yyyy)

Time Offense Occurred

Occurred From: (ex. 12:00AM)

Occurred To: (ex. 1:00AM)

Address or Location of Crime

Name of business or landmark, if known

Email Address of Victim

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.

STEP 2: If the Victim is a BUSINESS, please complete the following fields:

Business Name

Business Address

Business Phone

STEP 3: If the Victim is a PERSON, please complete the following fields:

Full Name of Victim

First

Middle

Last

Address of Victim

Zip Code of Victim

Home Phone of Victim

Alternate Phone

Age of Victim

Date of Birth of Victim

Victim's Employer

Victim's Employer's Address

Victim's Work Phone

Gender of Victim

Male

Female

Race of Victim

	White		Pacific Islander
	Black		American Indian
	Asian

Ethnicity of Victim

Hispanic

Non-Hispanic

STEP 4: If you are NOT the victim, please complete the following fields:

Relationship to Victim

Your Full Name

First

Middle

Last

Your Full Address

Your Phone Number

Your Email Address

Your Date of Birth

Your Age

Your Gender

Male Female

Your Race

	White		Pacific Islander
	Black		American Indian
	Asian

Your Ethnicity

Hispanic

Non-Hispanic

STEP 5: Description of the Suspect:

Suspect's Gender: Male Female

Suspect's Race: White Black Asian Pacific Islander American Indian

Suspect's Ethnicity: Hispanic Non-Hispanic

Please provide a complete description in the box below. Include approximate height, weight, clothes worn, facial hair, scars, tattoos, hair color, eye color, and description of vehicle driven by suspect:

STEP 6: Description of the Crime:

Please be Specific when describing the details of the crime you are reporting:

Method of Entry: Vehicle Burglaries
Pick the category that best describes the entry used by the suspect:

Point of Entry: Vehicle Burglaries
Pick the category that best describes the point of entry:

STEP 7: Complete this section for (L) Lost (S) Stolen or (D) Damaged property:

Lost or Stolen or Damaged			Description of Item	Make	Model	Serial#	Est $ Amt.
L	S	D
L	S	D
L	S	D
L	S	D
L	S	D
L	S	D

STEP 8: If a vehicle was involved in any way, you MUST complete the following section:

How was Vehicle Involved?

Vehicle License Number

State of License Plate

Vehicle Make

(Ford, Chevrolet, Dodge, Toyota, etc.)

Vehicle Model

(Ranger, Camero, Stealth, Camry etc.)

Vehicle Type

(Pickup, Van, Convertible, 4dr. etc)

Vehicle Year

Vehicle Identification Number (VIN)

(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)

Comments

STEP 9: Submit Form or Reset Form

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.