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2. If you are the VICTIM of a crime, do not complete this form - Please call the Carbondale Police Department at 618-457-3200. This form is only for witnesses or persons with knowledge of a crime.

4. Are you a victim of a crime?*

   1. Yes
   2. No

6. If yes, do not complete this form. Call the Carbondale Police Department at 618-457-3200.

8. Did you witness a crime?*

   1. Yes
   2. No
9. Do you have knowledge of a crime?*

   1. Yes
   2. No
10. Today's Date*
    Today's Date
12. Offense Location*
14. Type of Crime*
    -- Select One --BatteryBurglaryDamage to PropertyDrugsHomicideTheftTraffic OfensesOther
16. If Other, Please Explain
18. Date & Time of Offense
    Date & Time of Offense

    Date & Time of Offense
20. Details of Offense*
22. How do you know this information?
24. Is this a tip that relates to a previously entered tip?

    1. Yes
    2. No
25. If Yes, Please Enter the Tip Number
29. Suspect 1
31. Name
32. Alias
34. Address
36. Gender

    1. Male
    2. Femal
37. Race
    -- Select One --African AmericanAsianCaucasianHispanicNative American
38. Age
    -- Select One --Under 1818 - 2930 - 3940 - 4950 - 5960 and Over
40. Height
41. Weight
43. Hair Color
44. Eye Color
46. Scars / Marks / Tattoos
48. Vehicle Color
49. Make
51. Model
52. Year
54. Plate Number
55. Distinguishing Characteristics
57. More Information
61. Suspect 2
63. Hair Color
64. Eye Color
66. Plate Number
67. Distinguishing Characteristics
69. More Information
73. Suspect 3
75. Hair Color
76. Eye Color
78. Plate Number
79. Distinguishing Characteristics
81. More Information
Leave This Blank:


83. 1. Receive an email copy of this form.
84. Email address

    This field is not part of the form submission.

85. Submit

* indicates a required field