Complaint Report for Submission to the New York City Police Department Would you please issue a complaint report for my incident. Date ( date month year VICTIM( Last Name( First Name( Date of Birth( date month year Nationality( Address( Address in New York( How long will you be at this address? ( PERSON SUBMITTING REPORT (if different than victim Last Name( First Name( Birth Date( date month year Relationship to Victim( Nationality( Address( Address in New York ( How long will you be at this address? (
DATE/TIME OF INCIDENT ( date month year (am/pm time minute LOCATION OF INCIDENT( Area( (1 ( * Manhattan Queens Bronx Brooklyn Staten Island Roosevelt Island (2 Outside of NYC( Street( Cross Street (if known ( Subway/Train Station( Airport( * Commercial Premises A Bank B Bar and Grill C Book/Card D Candy/Ice Cream E Chain Store F Check-cashing G Doctor/Dentist H Dry cleaner/laundry I Factory/Warehouse J Fast Food K Food Supermarket L Gas Station M Grocery/Bodega N Hotel/Motel O Jewelry shop P Liquor Store Q Restaurant/Diner
R S T U V W Photo/Copy Social Club Shoe Store Variety/Discount Clothing/Boutique Drugstore/Pharmacy A B C D E F G H I J K L Non-Commercial Premises 1-2 family dwelling Abandoned building Apartment house Street Cemetery Gypsy taxicab House of worship Licensed taxicab Park/playground Parking lot Public garage Public housing Exact Location Elevator Lobby/Doorway/Vestibule Hallway/Stairway Rest room Office area Basement/Laundry room Rooftop Motor Vehicle I Railroad or Airport terminal J Bridge/Bus/Ferry terminal K Freight elevator L Garage/driveway
5.CIRCUMSTANCES OF INCIDENT( Luggage Thief( Pick Pocket ( Threat( Fraud( Snatcher( * by motorcycle( by car( Armed Robber( * by gun( by knife( 6.M.O Information M.O. Information Statement by Perp. (specify Asked questions/offered assistance Push-in Followed/stalked complainant Took to isolated area (abandoned building/back room Entry through window or fire escape Perp. Offered sex for sale Jump out of vehicle then victimized I Note is passed J Payoff K Hijack/carjack L Con game M Purse/pocketbook, O Neck chain Actions Towards Complainant Struck with object Stabbed or cut Fired/shot Tied up or handcuffed Made victim strip
Tortured Injury using physical force Impersonation Of: Law enforcement officer Male Female Customer/client Utility/public service/maintenance Security officer LOST/STOLEN PROPERTY( * Item Approx. Value Identification Cash $/ TC $/ Credit Cards $/ Airline tickets $/ Passport $/ Photo ID $/ Licenses $/ Camera $/ Video camera $/ Cell phone $/ PDA $/ Computer $/ Wallet $/ Handbag $/ Backpack $/ Briefcase $/ Fanny Pack $/ Carry-on luggage $/ Duffle Bag $/ Suitcase $/ Trunk $/ Accessories Necklace $/ Ring $/ Earrings $/ Watch $/ Other accessories $/ Total Amount of the damage $/
DESCRIPTION OF THE OFFENDER( Did you see the offender? ( * Yes( No( Number( * Alone( Several( How many people?( Sex( * Male( Female( Other Distinction( * Adult( Child( Age( * Young( Middle Age( Old( about years old Height( * Tall ( Short( Average( DETAILS OF THE CRIMINAL( ABOUT THE PRINCIPAL OFFENDER( Complexion Fair/light/pale Ruddy/flushed Dark Olive Light brown Dark brown Yellow Hair Style Kinky Afro Braids or cornrows Curly or wavy Partially bald Bald Straight Dreadlocks I Wig J Crewcut
K L Caesar Processed Distinguishing Body Marks Scar Birthmark Tattoo word only Tattoo picture only Tattoo words and picture Tattoo unknown type Mark Location Face/head Neck Torso Hand Leg Arm Mark Type Scar Birthmark Tattoo word only Tattoo picture only Tattoo words and picture Tattoo unknown type Deformities/Peculiarities Teeth Nose Eyes Ears/earrings Arm/hand deformity, amputee Tracks Odor Lips (fat, harelip, etc. I Pocked/pimpled J Freckled K Limp L Left handed M Eyebrows (bushy
N O Leg amputee Very muscular Headgear Stocking cap Cowboy hat Baseball Cap Applejack Ski cap or watch cap Straw hat or fedora Beret/Military cap Turban I Skullcap J Masked Headgear Color Brown Black Blue or Purple Red or Maroon Green Tan or Beige White Silver/Gray I Orange J Yellow/Gold K Multi-colored or striped L Light M Dark Outerwear Sweatshirt or jogging jacket Leather, suede or fur-trimmed Military Snorkel, ski-hooded jacket Gang, team or school jacket Sport jacket or dress jacket Sweater or vest Waist-length jacket I Overcoat or topcoat J T-shirt or tank top
Outerwear Color Brown Black Blue or Purple Red or Maroon Green Tan or Beige White Silver/Gray I Orange J Yellow/Gold K Multi-colored or striped L Light M Dark Other Clothing / Accessories Messy, dirty, torn clothes Well-dressed Slacks Shorts Jeans Uniform work clothes Sweat/jogging pants Dress/skirt I Scarves, bandana, sweatband J Jewelry K Tools or keys L Bag or briefcase Other Clothing/Accessories Color Brown Black Blue or Purple Red or Maroon Green Tan or Beige White Silver/Gray I Orange
J K L M Yellow/Gold Multi-colored or striped Light Dark Footwear Jogging shoes Dress shoes Cowboy boots Work boots Sandals Campus/casual/loafer/moccasin Barefoot High-heeled I Sneakers Footwear Color Brown Black Blue or Purple Red or Maroon Green Tan or Beige White Silver/Gray I Orange J Yellow/Gold K Multi-colored or striped L Light M Dark
ABOUT THE ACCOMPLICE( Mark Location Face/head Neck Torso Hand Leg Arm Other Clothing/Accessories Messy, dirty, torn clothes Well-dressed Slacks Shorts Jeans Uniform work clothes Sweat/jogging pants Dress/skirt Scarves, bandana, sweatband Jewelry Tools or keys Bag or briefcase Other Clothing/Accessories Color Brown Black Blue or Purple Red or Maroon Green Tan or Beige White Silver/Gray I Orange J Yellow/Gold K Multi-colored or striped L Light M Dark