On Line Crime Report

Sheriff's Office Online Crime Report

In order for your report to be properly handled, the information given must be as complete and accurate as possible. Please fill in the following information regarding the reported incident and click the submit button at the bottom of the form.

After the information is received, you will be contacted with a Case Number by return e-mail. Please ensure that your correct e-mail address is listed in the appropriate box below.

The Jefferson County Sheriff's Office can only take online reports for property crimes less than $1000 or suspicious activity.

All other crimes of a more serious nature must be processed through the 911 emergency system. If you have suspect information (more than a hunch) or physical evidence you MUST call 911 and talk to a deputy. These reports are considered informational and will not be actively investigated.

If you wish to report a more serious crime, please call 911.

Note: The information submitted through the Online Crime Form is confidential and treated as such under the applicable laws of the State of Washington. The information is never sold or disseminated commercially. The information may be shared with other law enforcement jurisdictions as necessary to pursue the adjudication of your case.

Please note: This form is intended for crimes of less than $1000 in value. Do you wish to disclose the following information gathered in this report? (Case reports are public documents. By indicating No, the amount of information released is limited)
Yes No

Please choose the type of incident from the list below:
*required

Today's Date:
(Example: MM/DD/YYYY)

Date Incident Occurred:	Approximate Time Incident Occurred:
(Example: MM/DD/YYYY)	(Example: 3:30 or 15:30) AM PM

Please provide the following information about where the property was taken, found or damaged: * indicates required information
Incident Location (Business Name)	*
Incident Address	*
Address (cont.)
City	*
State	*
Zip/Postal Code	*

Please provide the following information about yourself:
Name: Last, First, Middle	*
Date of Birth (MM/DD/YYYY)	*
Race
Sex	Male Female
Height	feet inches *
Weight (lbs.)	*
Eye Color	*
Hair Color	*
Driver's License Number (or State ID Number)	*
State Issued:

Home Street Address	*
Address (cont.)
City	*
State	*
Zip/Postal Code	*
Country
Work Phone (include area code)
Home Phone (include area code)	*
E-mail	*
Employer/School

Please provide the following information regarding your vehicle ONLY if it was involved in the incident:
Vehicle License Number
State
Vehicle Identification Number (VIN)
Year
Make of vehicle (Ford, Toyota)
Model (Escort, Celica)
Style (2 dr,4 dr, SUV,PU truck, SW )
Color
Registered Owner
Estimated Amount of Damage
Incident Description: Use the space provided below to describe the incident and property. Be sure to include information about: Who \| What \| When \| How \| Why \| Where

Specific Information about items involved: serial number, value, description. Please be as detailed as possible. If there are more items involved than the form allows, please include them in the Incident Description.

1 - Items Taken/Damaged
Incident Type
Quantity
Brand
Model
Color or other descriptor
Serial or OAN Number
Value)

2 - Items Taken/Damaged
Incident Type
Quantity
Brand
Model
Color or other descriptor
Serial or OAN Number
Value

3 - Items Taken/Damaged
Incident Type
Quantity
Brand
Model
Color or other descriptor
Serial or OAN Number
Value
If there are more items involved than the form allows, please include them in the Incident Description.

Please provide a total dollar-amount estimate for the property described *Please note: This form is intended for crimes of less than $1000 in value.*

I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.

© 2002 -2006 Jefferson County Sheriff's Office
79 Elkins Road, Port Hadlock, WA 98339
Telephone: (360) 385-3831 | FAX: (360) 379-0521 | Emergency: 911
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