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2. Simple Larceny (Valued at less than $1,000)
   A person is guilty of this offense if they take personal property in the possession of another and carries it away without the consent of the possessor and with the intent to deprive the possessor of its use permanently knowing that he or she was not entitled to it.
4. I am the (select one)*

   1. Victim

   1. Witness

   1. Third party
6. First Name*
7. Last Name*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Phone Number including area code:*
18. Email
20. If you are a third party reporting a crime, please state who you are reporting for:
22. First Name
23. Last Name
25. Address1
27. Address2
29. City
30. State
31. Zip
33. Location of Incident/Crime:
35. Common name of place if applicable (ie: Holiday Inn, Jacksonville Mall, etc.):
37. Address1
39. Address2
41. City
42. State
43. Zip
45. Date and Time Incident occurred*
    Date and Time Incident occurred Start Date

    Date and Time Incident occurred Start Time

    —

    Date and Time Incident occurred End Date

    Date and Time Incident occurred End Time
47. Description of Incident
49. Description of Item
51. Make
52. Model
53. Serial Number
55. Description of suspect
    Enter here any description you can provide of the suspect (ie: height, weight, race, clothing, age, sex, unusual markings such as tattoos or scars, etc) If known, include name of suspect.
Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit

* indicates a required field