LINCOLN COUNTY SHERIFF’S OFFICE
LINCOLN COUNTY SHERIFF’S OFFICE
Lincoln County Sheriff’s Office Statement Form
Long Term Call Number: _____________ Case Number: ______________________
To be attached to original incident report made by the investigating officer
Name: ___________________________________________________ Date: _____________________
DOB: ________________ SSN: ___________________ DL# __________________________________
Address: ____________________________________________________________________________
Phone: ____________________ /___________________________ /_____________________________
Home Work Cell
PLEASE PRINT CLEARLY
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Signature ____________________________________________ Date: __________________
REVISED 6/01/2018
Continued…
____________________________________________________________________________________________________________________________________________________________
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Signature ____________________________________________ Date: __________________
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KERRY D. LEE
Sheriff
klee@lcso-
Pioche Main Station
P.O. Box 570
225 Justice Way
Pioche, NV 89043
775-962-5151
Fax: 775-962-5384
Alamo Substation
P.O. Box 390
121 Joshua Tree St
Alamo, NV 89001
#775-725-3800
Fax: 775-725-3629
Caliente Substation
100 Depot Ave
Caliente, NV 89008
#775-962-5151
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