Type of Crime:

Date Crime Occurred:
Address or Area Where Crime Occurred:

Time Crime Occurred:
HH:MM am/pm
Victim Information:
 First Name:

Middle Name:

Last Name:

Business Name (if Victim was Business):




City, State and Zip:
Home Phone Number:
Business Phone Number:
E-Mail Address:
Victim's Date of Birth:
Victim's Race:

Reporting Party Information:
(If you are filing this report for the Victim or Victim Business, please fill out the following)
First Name:

Middle Name:

Last Name:

Phone Number:


City, State and Zip:
Crime Information:

Description of Crime Scene (Back Yard, Driveway, Side Yard, Detached Garage, Public Street, etc.):

Description of the Crime:
(Describe in as much detail as possible exactly what occurred.  Include time frame in which the crime occurred.  Example: Crime occurred sometime between 9pm on 08/25/04 and 6am on 08/26/04.)
Stolen Property:
Description: Make Model Serial Number Value
Suspect Information:
Please describe any suspects in as much detail as possible.  Include such information as height, weight, build, age, race, hair and eye color, facial hair, tattoos, scars, clothing, etc.  If the suspect is known to you please do not use this form.  Instead call the Lodi Police Department at (209)333-6727.

Vehicle Information:
Vehicle Involvement:

Vehicle License Number:

Vehicle State:

Vehicle Make:

Vehicle Model:

Vehicle Type (2dr, 4dr, Van, Pickup, Etc.):

Vehicle Year:

Vehicle Colors:

Additional Comments:


Copyright 2007 [Lodi Police Department]. All rights reserved.
Revised: 2/27/2007