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Sample Crime Report Template

This document appears to be a citizen's crime/incident report form from the Lompoc Police Department used to report details of a crime or incident including dates, locations, descriptions of people and vehicles involved, stolen/lost property, and a narrative section. The form collects information like names, addresses, phone numbers, and descriptions of those involved coded by their role in the incident. Submitting citizens must sign to acknowledge the truth and accuracy of the reported information.

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1K views2 pages

Sample Crime Report Template

This document appears to be a citizen's crime/incident report form from the Lompoc Police Department used to report details of a crime or incident including dates, locations, descriptions of people and vehicles involved, stolen/lost property, and a narrative section. The form collects information like names, addresses, phone numbers, and descriptions of those involved coded by their role in the incident. Submitting citizens must sign to acknowledge the truth and accuracy of the reported information.

Uploaded by

api-454387158
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MCPD

LOMPOC POLICE DEPARTMENT


Complaint#: (ofc. use only)

Case #: Page #:
Citizen’s Crime / Incident Report
Crime/Incident: (Describe the Incident)

Date / Time Occurred: (On or Between) To : Date/Time Reported:

Location: Lompoc

Person/Vehicle Codes: R-Reported by V-Victim W-Witness P-Parent C-Contact O-Owner D-Driver X-Other
Race/Ethnic Codes: W-White B-Black H-Hispanic I-American Indian C-Chinese P-Pacific Islander O-All Others X-Unknown

Code: Last Name: First: Middle: Race: Sex: Age: DOB:

Residence: Lompoc Res./Msg. Phone #:

Business/School: Lompoc Occupation (grade): Bus./School Phone #:

Driver’s License / I.D.# State Social Security #: Cell Phone #:

Code: Last Name: First: Middle: Race: Sex: Age: DOB:

Residence: Lompoc Res./Msg. Phone #:

Business/School: Lompoc Occupation (grade): Bus./School Phone #:

Driver’s License / I.D.# State Social Security #: Cell Phone #:

Veh.: Yr.: Make: Model: Style: Misc. Description: License #:

Describe any damage: Value:

Veh.: Yr.: Make: Model: Style: Misc. Description: License #:

Describe any damage: Value:

Details of the incident: (continue on page 2 if necessary)

I DECLARE THAT THIS REPORT AND THE INFORMATION CONTAINED HEREIN IS TRUE, CORRECT, AND
COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I FURTHER ACKNOWLEDGE THAT ANY
INTENTIONAL FALSE STATEMENT OR MISSTATEMENT MAY BE A VIOLATION OF SECTION 148.5 OF THE
CALIFORNIA PENAL CODE.

Reporting Persons Name: Signature: Date:

LPD # XXX (08/2006)


LOMPOC POLICE DEPARTMENT
Case #: Page #:
Citizen’s Crime / Incident Report
Stolen and / or Lost Property Description
Item # Description (include brand, model, size, color etc) Serial # Value:

NARRATIVE — Describe in detail what occurred. Use extra sheets if needed. PLEASE PRINT LEGIBLY IN INK

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

FOR OFFICIAL USE ONLY


Final Classification:

Copies To:
Records Detectives Traffic Other:
Clerk: Supervisor Approval: Date:

LPD 511 (rev 3/99)

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