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If you would prefer to fill out the form and deliver it manually, click here for a printable blank form.
- Date and Time of Occurrence: List the date and time the crime / incident occurred.
- Date and Time Reported: List the date and time you completed the report.
- Location of Occurrence: List where the crime / incident occurred (i.e. home address, business, etc.)
- Reporting Person, Phone Number: List the First, Middle and Last name of person reporting the incident and best phone number you can be contacted at.
- Home Address: List the current address of person reporting the incident. Please include city, state and zip code.
- Date of Birth, Sex and Occupation: Self explanatory.
- Summary of Crime / Incident: Briefly describe what occurred.
- Property Loss: Provide the following information if items were taken during the incident. Leave blank or write N/A if not. Use a blank page if there is additional property.
- Brand/Manufacturer: List the name of the maker of the item (N/A if unknown)
- Description: Brief Description of the item
- Serial Number: List the number if available (N/A if unknown)
- Value: List the estimated amount you paid for the item (N/A if unknown)
- Quantity: List the number of the listed item taken
- Victim's Name, Home Address, Date of Birth, Sex, and Occupation: List the name of the victim in the report and the following information (Only if it is different from the reporting person information).
**It is suggested that you make a copy of the report, once completed, for your own reference prior to dropping it off, mailing it in or emailing it. Thank you.
If you have any additional questions regarding how to complete this report, please contact the Porterville Police Department at (559) 782-7400.