Lost Property Report

2. Do Not Write in This Section - Police Department Use Only

4. Date

5. Case Report Number

9. Describe Your Lost Items

11. Item #1

12. Color

13. Value of Item

15. Identifying Numbers or Marks

17. Item #2

18. Color

19. Value of Item

21. Identifying Numbers or Marks

23. Item #3

24. Color

25. Value of Item

27. For further items, please fill out another form. Will you be filling out an additional form or forms regarding more lost items?*

    1. Yes

    1. No

29. Briefly Describe How These Items Were Lost

33. When do you believe your items were lost?

35. Between This Date*

36. At This Time*

37. And This Date*

38. At This Time*

40. Where do you believe your property to be located?

42. Address1

44. Address2

46. City

47. State

48. Zip

52. First Name*

53. Last Name*

55. Address1*

57. Address2

59. City*

60. State*

61. Zip*

63. License / ID Number*

64. State*

65. Your Race

66. Gender*
    -- Select One --FemaleMale

68. Agreement of Terms*
    -- Select One --Yes, I understand these terms.

    I understand that making a false report to a police agency is a Class A Misdemeanor, punishable by up to one year in the county jail and/or a fine of no more than $2000.

69. Today's Date

73. Do Not Write in This Section - Police Department Use Only

75. Date Processed

76. Approved By:

Leave This Blank:


77. 1. Receive an email copy of this form.
78. Email address

    This field is not part of the form submission.

79. Submit

* indicates a required field