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Suspected Drug Activity Reporting Form

*All information submitted on this form is kept confidential.
Address of Suspected House
Address2
City
State
Zip
Description of House
Doors Used by Customers
Rental
1. Yes
2. No
Comments
(Why do you believe this is a drug house?)
Hours of Operation
(Days of week, busiest times)
Residents
(Name, nickname, race, age, sex)
Residents Vehicles
(Color, make, model, license plate number)
Person Reporting (Optional)
This information is kept confidential.
First Name
Last Name
Address1
Address2
City
State
Zip
Home Phone
Work Phone
Email
All information submitted is kept confidential.

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Email address

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