Police Liaison Group - PLG Incident Report Form

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PLG Incident Report Form

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POLICE LIAISON GROUP “PLG”
Incident Report Form

Call 911 immediately to report a crime in progress and follow up by filling out the Incident Report Form below. Please describe the perpetrators and circumstances of the incident as thoroughly as possible.

This information will be used by Police Liaison Group and the police to prevent and solve crimes. For further details please read our Privacy Policy.

Your Name: (optional)

Your E-mail: (optional)

Street Address: (optional)

City:

State:

ZIP Code:

Telephone (include area code): (optional)

Name of Victim: (optional)

Age of Victim(s):

Gender of Victim(s):

Does Victim(s)/victim(s)’ family wish to be contacted by:	SUN yes / no
	the NYPD yes / no
by another agency? please specify:

Contact Information of Victim(s) or Victim(s)’ Parents, if minors (optional):

May SUN provide your name and contact information to the NYPD should they have additional questions concerning your incident report? Yes No

Police Complaint Number (if filed):

Names, precincts and contact information of officer(s) you spoke with:

Complaint Filed:

(YYYY)

Description of Suspect(s) and Incident (complete as much of this information as possible). For descriptions of additional perpetrators, complete boxes at the bottom of this form:

Name (if known):

Race:

Sex:

Age (approximate):

Height:

Weight:

Hair (color and style):

Eyes (color):

Glasses (frame - wire, round, color etc.):

Beard or mustache:

Unusual Features:

Visible marks or scars:

Clothing (visible garments - hat, coat, shirt, trousers, shoes, etc.):

Weapon (knife, pistol, shotgun, etc.):

Direction/manner of escape (foot or vehicle):

Vehicle Description (make, model, color):

License #:

Date of Incident (mm/dd/yyyy):

Time of Incident:

am pm

Location of Incident:

Address:

Cross Streets:

Corner (Northwest, Southeast, etc.):

What Occurred?

Was any property taken? (wallet, i-pod, cellphone, etc.)

Type of crime:

Additional Comments:

Please Include

1. suspect(s)’ motive(s) if known,

2. what prompted you to take the action you did concerning the incident

a. My instincts told me to...

b. What was of greatest concern to me was...

By making this report, I am hoping that...

Description of Suspect #2: