Form Center

2. CITIZEN REPORT
4. Date Reported*
5. Time Reported
7. The theft or property damage crime occurred within the Mount Vernon City limits*

   1. Yes
9. This report is intended for theft or property damage $750 or less & no suspects*

   1. Yes, the loss is $750 or less and no suspects are known
   2. No, the loss exceeds $750
11. If the loss exceeds $750, report it by calling (360) 428-3211.
15. Nature of Crime*

    1. Theft
    2. Vandalism
16. Date of Offense*
17. Time of Offense*
19. Address - Where the offense occurred*
21. City*
22. State*
23. Zip*
27. REPORTING

    1. I'm the victim
    2. I'm reporting for the victim
29. VICTIM INFORMATION
31. First Name*
32. Middle Name*
33. Last Name*
35. Birth Date*
36. E-mail Address*
38. Address*
40. City*
41. State*
42. Zip*
44. Home Phone*
45. Business Phone
46. Mobile Phone
50. REPORTING PARTY
51. (Only if you are not the reporting victim)
53. First Name
54. Middle Name
55. Last Name
57. Date of Birth
58. E-mail Address
60. Address1
62. City
63. State
64. Zip
66. Home Phone
67. Business Phone
68. Mobile Phone
72. MISSING OR DAMAGED PROPERTY
74. Property Item #1
75. Value or Repair Cost
76. Invoice or Estimate Copy
78. DESCRIBE: Identifying marks, serial or model numbers, color, etc.
80. Do you have a photograph?
81. Additional photograph
85. Property Item #2
86. Value or Repair Cost
87. Invoice or Estimate Copy
89. DESCRIBE: Identifying marks, serial or model numbers, color, etc.
91. Do you have a photograph?
92. Additional photograph
96. Property Item #3
97. Value or Repair Cost
98. Invoice or Estimate Copy
100. DESCRIBE: Identifying marks, serial or model numbers, color, etc.
102. Do you have a photograph?
103. Additional photograph
107. THEFT/DAMAGE
109. Please describe the circumstances surrounding the incident
111. Are you willing to pursue charges if the perpetrator is identified?

     1. Yes
     2. No, not at this time
112. Did the perpetrator use a vehicle

     1. Yes
     2. No
114. Suspect vehicle description (License plate, Make, Model, Color, Identifying Marks)
118. I UNDERSTAND FILING A FALSE POLICE REPORT IS A CRIME IN WASHINGTON STATE.*

     1. Yes, to the best of my ability, the information I've provided is true and correct.
122. Thank you, please contact us if we can be of additional assistance or if circumstances in this case change.
Leave This Blank:


124. 1. Receive an email copy of this form.
125. Email address

     This field is not part of the form submission.

126. Submit

* indicates a required field