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    • Confidential Drug Activity Report Form

    Please read the introduction prior to completing

    Please include as much information as you can in the form below. Incomplete or inaccurate information will delay processing of this report and may compromise our ability to quickly and effectively respond to this complaint.

    Although this form is lengthy, the information is important. If you were reporting the information to a police officer in person, you would likely be asked similar questions. Please provide as much information as possible so that we may address the issue without delay. This form is for Arlington County only, please.

    This report consists of several pages. All fields are required unless otherwise noted.
    Approximate completion time: 15 minutes

    Today's date is 5/25/2012 , The current time is 4:29:38 AM

    (click here for more information)
    Where does the drug activity occur?
    : (optional)
    (optional)
       
    Please tell us about the security at this location.
    Help us know what we are facing. If you don't know the answer, leave it blank. Do not guess or assume.
    Have you see guns at this location?
    Are there dogs at this location?
    Are the doors reinforced or gated?
    Are the windows reinforced or gated?
       
    Please tell us about the activity.
    Do not guess or assume.

    (You may select multiple drugs by holding down the Ctrl key and clicking on multiple selections.)
    :

    When is the activity present? (DO NOT EXAGGERATE)


    When is the the location most active?
    (DO NOT EXAGGERATE)















    Please provide information about the drug dealer. If you don't know or are unsure, please enter "NA" into the appropriate field.
    :
    :
    :
    :
    :
    : (optional)
    : (optional)
    : (optional)
    : (optional)
    : (optional)
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    Please describe the dealer's appearance. Include scars, marks, tattoos, clothing style, jewelry, hair style, and any distinguishing characteristics.

    Please tell us about any associates of the dealer.
    :
    names, nicknames, ages, race, gender. (optional)

    Please describe the dealer's vehicle. (optional)
    : (i.e., Ford)
    : (i.e., Bronco)
    :
    :
    :
    :
    Describe unique identifiers of the vehicle such as damage, distinct paint colors, unique parts.    		 (optional)

    Please tell us about yourself.
    May we call you for more information? No Yes (Name and phone or email required)
    : (optional)
    : (No P.O. Boxes) (optional)
    : (optional)
    : (optional)
    : (optional)
    : (optional)
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