ACTIVITY DETAILS

Drug Being Sold  Please Select One Crack Cocaine Cocaine-Powder Heorin Ice/Methamphetamine LSD Marijuana PCP/Angel Dust Other    If other, Please Describe:        

Place of the Activity   Please Select One Inside Business Inside Private Residence Alley or Driveway Hallway Park Sidewalk - Street Corner Vacant Lot Vehicle Other    If Other, Please Describe: 

Address  

VEHICLE INFORMATION

(If Applicable)

Vehicle Type   4 Door Sedan 2 Door Coupe Hatchback Convertible Station Wagon SUV Van Pickup Truck Other   If Other, Please Describe      Manufacturer  

Model      Color      License Plate      License Plate State  

SECURITY DETAILS

(Do not guess.  If you do not know, indicate as such.)

Have you seen weapons at this location?  Yes   No   Do Not Know    Are There Dogs Inside Location? Yes   No   Do Not Know

Are the Doors Reinforced or Gated?   Yes   No   Do Not Know  Are the Windows Reinforced or Gated?Yes   No   Do Not Know

YOUR INFORMATION

Name      Address      City      State  

Phone #      Email Address      May We Contact You?   Yes   No

Additional Comments