Confidential Narcotics Report Form

Use this form to report narcotics activity or drug dealers that you observe in your neighborhood. The information you provide will help us successfully respond to the problem of drug trafficking in your community. Please complete as much of the form as possible. You may submit this form as often as necessary. Please complete a separate form for each location and/or suspect that you wish to provide information about.

The information you submit will be forwarded to an investigator in your area for further investigation and enforcement. Investigators may contact you for additional information if you wish. If you choose to remain anonymous, however, be assured that the information you provide will be acted upon.

Important Numbers

Narcotics Unit
(216) 443-6095

Anonymous Complaint Line
(216) 443-6028

Tip Line
(216) 443-6265
(216) 443-6256

Location of Activity

Street Address

Select a choice

Zip Code

Location Security

Help us determine what we're up against so we can take the necessary precautions. If you don't know, please leave this section blank.

Have you seen guns at this location?

Yes

Are there any lookouts?

Yes

Are there any children at this location?

Yes

If yes, please specify number of children below:

Number of Infant(s)

Number of Toddler(s)

Number of Young Children

Number of Teen(s)

Are there dogs at this location?

Yes

Activity Details

Type of Drug Activity

Cocaine

Heroin

Marijuana

Other...

Describe the Activity

Use this area to tell us about the activity being reported. Explain as much in detail about the situation as you can.

Remember, you can't tell us too much!

Drug Dealer Information (if known)

Dealer's Name

Dealer's Nickname

Dealer's Age

Dealer's Phone Number

Dealer's Race

Dealer's Sex

Dealer's Address

Select a choice

Dealer's Zip Code

Dealer's Description

Please describe the violator's appearance. Include scars, tattoos, clothes, jewelry descriptions, hair styles and any other distinguishing marks. If you can't provide a description enter "Unknown" in this space.

Vehicle Type

Vehicle Manufacturer

License Number

Vehicle Year

Vehicle Model Name

License Plate State

Vehicle Color

Unique Features

Describe any unique features like damaged parts, accessories, sun roofs, etc. The idea is to give us a unique description of the car so we can immediately recognize it.

Your Information

This area is completely optional. You do not have to provide this information to us. If you decide to, we will use it only to contact you for additional information. This information will be kept strictly confidential.

First Name

Last Name

Phone Number

Street Address

Select a choice

Zip Code

May we call you for additional information?

Yes

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