Kenosha Police Department Citizen Self-Reporting Procedure

Kenosha Police Department Citizen Self-Reporting Procedure

The Citizen Self-Reporting form is available to report non-emergency incidents. If a crime is in progress, or if the incident is an emergency, dial 911.

This form is only valid for non-emergency crimes that occurred within the City of Kenosha, Wisconsin. If the crime did not occur in Kenosha, you will need to file a report in the jurisdiction that the incident occurred.

This form can be used to report the following: ? Theft, Vandalism or Criminal Damage to Property Complaints: ? Not in progress ? No suspects or witnesses ? No evidence is known to exist ? Loss does not exceed $1000.00 ? Lost Property: ? Loss does not exceed $1000.00 ? Civil Dispute ? Fraud/ ID Theft ? Information ? Stolen Bicycle ? Stolen License Plate ? Theft from Auto (Unless it involves a firearm) ? Worthless Checks

If the incident that you wish to report is not listed above, please contact the Kenosha Police Department at (262) 656-1234 for all non-emergency incidents.

Instructions to complete the Citizen Self-Reporting Form

INSTRUCTIONS: This is an official Law Enforcement document that will become the official police report for this incident. If you have insurance coverage, this form will assist you in filing a claim. Please note that you must include your FULL NAME and BIRTHDATE for the report to be officially filed. We will be better able to follow up on your case if you provide us with as much information as possible. Email completed form to kpdcsr@.

SECTION 1 ? GENERAL INFORMATION

This section must be completed in order for us to properly record the incident. If you are not sure of the specific time of the incident, record the range of time during which the incident occurred. Your home and work addresses and phone numbers are important if there is a need for us to contact you.

SECTION 2 ? BUSINESS INFORMATION

If the incident occurred at a business, or if property involved is owned by someone other than you, list that information here. If you own the property involved, simply write "SAME" in the Property Owner's Name box in this section.

SECTION 3 ? VICTIM VEHICLE

Use this section to identify any vehicles involved in the incident. If you are not the owner of the vehicle, list the registered owner's information.

SECTION 4 ? STOLEN AND/OR DAMAGED PROPERTY

Use this section to identify any property which was stolen or damaged. Be as specific and complete as possible, being sure to indicate anything which will separate your property from someone else's property. Please identify your insurance company in the space provided.

SECTION 5 ? FRAUD, SCAM, OR IDENTITY THEFT

Use this section to provide bank or credit card company information or the type of scam that you want to report. This form cannot be used to report bank or credit card fraud transactions, unless you have already disputed the transactions.

SECTION 6 - NARRATIVE

This section must be completed for us to properly record your complaint. Please offer as much information as possible to help us understand what happened. When you complete this section, be sure to print your name and sign and date your report in the spaces provided at the bottom of the page.

OFFENSE/INCIDENT

DO NOT WRITE IN SHADED AREAS

AGENCY/UNIT _______/______

DATE ____/____/_______

TIME

CASE NO.

TYPE OR PRINT INFORMATION REQUESTED BELOW USING BLACK INK

Today's Date

SECTION 1 ? MUST BE COMPLETED

Time Now

Date Incident Occurred

Time(s) Incident Occurred

Address where incident occurred. Use the block or nearest intersection, if the incident did not occur at a specific location.

Your Last Name Your Address ? Number Business Address ? Number

First Name Street Name Street Name

Middle Initial

Sex

Race

City

State

Zip

City

State

Zip

Birthdate ? Month / Day / Year _____/_____/_________

Phone Number (Home/Cell) (_____) ______-__________

Work Phone Number: (_____) ______-__________

SECTION 2 ? COMPLETE, IF APPLICABLE

Business Name or Property Owner's Name

Sex

Race

Home Address ? Number

Street Name

City

State

Zip

Business Address ? Number

Street Name

City

State

Zip

Birthdate ? Month / Day / Year _____/_____/_________

Phone Number (Home/Cell) (_____) ______-__________

Work Phone Number: (_____) ______-__________

Vehicle License Number

SECTION 3 ? VICTIM VEHICLE

State Exp. Month/YR

Type (auto, truck, etc.)

Vehicle Identification Number

Vehicle Year

Vehicle Make

Model

Body Style

Color: Top / Body

Owner's Last Name Owner's Address ? Number

First Name Street Name

Middle Initial Sex

Race

City

State

Zip

Birthdate ? Month / Day / Year _____/_____/_________ Work Phone Number:

(_____) ______-__________

SECTION 4 ? STOLEN AND/OR DAMAGED PROPERTY

List all available information ? Attach additional pages, if necessary. Check one (S-Stolen; D-Damaged; L-Lost)

Example

1

How Many

BIKE

Item

Select

Select

Select

Select

Select

Select

Select

Select

Select

Select

Select

Select

Select

Select

Select

Select

Select

Select

Insurance Company:

TREK

Brand

R750

Model/ Style

XYZ1234

Serial Number

SILVER

Color

NAME CARVED ON BOTTOM

Distinct Markings

$1500

Value

$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

SECTION 5 ? CHECK ALL THAT APPLY

BANK/CREDIT CARD FRAUD SCAM IDENTITY THEFT CONTRACTOR FRAUD OTHER

Has this been disputed with the bank/credit card company? (Check one) YES NO

If no, you must dispute the transaction(s) with your bank/credit card company prior to completing this form. Do you have supporting documentation of fraud? (Check one) YES NO

Scam (Check all that apply)

Phone Scam Mail Scam Computer Scam

Other (Check all that apply)

IRS Social Security State Aid Fraud

SECTION 6 ? MUST BE COMPLETED INCIDENT INFORMATION

Briefly describe incident ? Attach additional pages, if necessary.

For theft of or criminal damage to property crimes, the police must formally establish that the property owner did not give someone permission to steal or damage their property since consent is an element of these crimes. Please respond to the following:

Did you give consent to someone to steal or damage your property? (Check one) YES NO

Print Full Name:

Signature:

Date:

If signature box does not work, please check the box verifying that you completed the form and that the information you provided is true and accurate to

the best of your knowledge.

SUBMIT

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