Drug Complaint Submission Form

2. Complanant Contact Information
4. Name
5. Email Address
7. Mailing Address
9. City
10. State
11. Zip Code
13. Phone Number
15. Do you want contact?

    1. Yes
    2. No
16. Is there already a case number assigned?

    1. Yes
    2. No
17. Case Number
21. Specific Date and Time Occured
    Specific Date and Time Occured

    Specific Date and Time Occured
22. General Time Occuring
    -- Select One --MorningAfternoonEveningLate NightAll Hours
24. Address Where Crime Is Occuring
26. Address
28. City
29. State
30. Zip Code
34. Description Of What Is Occuring
36. Source Type

    1. Did you see this offense in person?
    2. Do you just think this is happening?
    3. Did you hear this from someone else?
40. Suspect Name
42. Nicknames or Aliases
44. Race
    -- Select One --American IndianAfrican AmericanAsianPacific IslanderWhite
45. Height
46. Weight
48. Eyes
    -- Select One --BrownBlueGreenHazel
49. Hair
    -- Select One --BlondeBrownGrayRedBlackBald
50. Hair Description
52. Scars/Marks/Tattoos

    1. Yes
    2. No
53. Scars/Marks/Tattoos Description
55. Facial Hair

    1. Yes
    2. No
56. Facial Hair Description
58. Suspect Vehicle Information

    Please include make, model, style, color and if there are any stickers, damage and/or distinguishing features. 

60. License Plate Number
61. License Plate State
63. Upload Picture or File

67. Thank you for your submission. Your information will be sent to a detective for review as soon as possible. If you need immediate assistance, please contact the Communications Center at 904-270-1661. 

69. 
71. For Internal Use Only:
72. Rcvd By ID
Leave This Blank:


74. 1. Receive an email copy of this form.
75. Email address

    This field is not part of the form submission.

76. Submit

* indicates a required field