Drug Activity Complaint Form

Please provide the following contact information:
**All complainant information is kept confidential. Please read the introduction prior to use.

First Name
Last Name
Street Address
Address (cont.)
City
Zip Code
Work Phone
Home Phone
E-mail

**Please provide as much information below as possible**
Address of suspected activity:

Street Address
Address (cont.)
City
Zip
Activity Location
Phone Number
Pager Number
Description of person that resides at suspect address:
First Name
Last Name
Age
Sex Male Female
Race
Height
Weight
Hair Color
Eye Color
Other person that resides at suspect address:
First Name
Last Name
Age
Sex Male Female
Race
Height
Weight
Hair Color
Eye Color
Other person that resides at suspect address:
First Name
Last Name
Age
Sex Male Female
Race
Height
Weight
Hair Color
Eye Color
Other person that resides at suspect address:
First Name
Last Name
Age
Sex Male Female
Race
Height
Weight
Hair Color
Eye Color

Type of drug (if known):

Cocaine
Heroin
Marijuana
Methamphetamine
Other

Suspect Vehicle (year/make/model/color):

Vehicle license plate (include State):

Other vehicles at suspected address (year/make/model/color):

Other vehicle license plate (include Sate):



How long has the suspected activity been occurring?


Please describe type of activity occurring and how you know the activity is occurring (personally observed, heard about, etc.):


Are there children residing at the suspected address? Yes  No

Have you observed other suspicious activity such as the following:

Look outs
Surveillance cameras
Weapons
Other