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Step One

Please read the following information to learn how to fill out this form
THEFT FROM AUTO: Property taken from the outside of a vehicle by another with NO suspect information. LOST PROPERTY: Property missing, but have no evidence that it was taken by another. DAMAGE TO AUTO: Damage to your vehicle that was intentional but NO Offender information. BICYCLE THEFT: Bicycle taken with NO offender information. GASOLINE THEFT: Gasoline theft in a drive off. MATTER OF RECORD: Information required for insurance purposes and no follow up by the police, or a report with no follow up by police on a non-criminal matter. TELEPHONE HARASSMENT: telephone calls received where calls are repetitive, annoying, or threatening (Caller may be known, and you desire no follow up by police) ELECTRONIC HARASSMENT: Electronic or text messages that are received by you and are annoying (Person may be known to you, and you desire no follow up by police) ACCIDENTAL DAMAGE: Damage that is reported and was unintentional. LOST LICENSE PLATE or DRIVER'S LICENSE: License plate missing from vehicle or lost driver's license- unknown if stolen or not. SUPPLEMENTAL REPORT: An additional report that needs to be filed from one that you already completed (Add the original number in this report). IDES IDENTITY THEFT: You received an IDES unemployment card in the mail and never filed for one.
REPORT NUMBER
The police department will provide when the report is filed
CHECK THE TYPE OF INCIDENT: These incidents will not have an identifiable offender.*
1. Theft from Auto
2. Lost Property
3. Damage to Auto
1. Bicycle Theft
2. Gasoline Theft
3. Matter of Record/Civil Matter
1. Phone Harassment
2. Electronic Harassment
3. Accidental Damage
1. Lost License Plate
2. Supplemental Report
3. IDES Identity Theft
YOUR INFORMATION
First Name*
Middle Initial
Last Name*
YOUR BIRTHDAY*
SEX*
1. Male
1. Female
Address1*
City*
State*
Zip*
Telephone Number*
Best contact number
Your Email Address*
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Step Two

INCIDENT LOCATION
Address1*
APT, SUITE OR UNIT#
NAME OF BUSINESS:
Provide Business Name if Applicable
City*
State*
Zip*
DATE OF THIS REPORT*
TIME RANGE
Please provide approximate times incident occurred.
DATE OF INCIDENT*
TIME OF INCIDENT*
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Step Three

VICTIM INFORMATION
First Name*
Middle Initial
Last Name*
DATE OF BIRTH*
SEX*
1. Male
1. Female
Choose one of the following:*
1. American Indian or Alaskan Native
2. Asian
3. Black or African American
4. Hispanic
5. Native Hawaiian or Other Pacific Islander
6. White
Address1*
Address2
City*
State*
Zip*
BEST CONTACT NUMBER*
VICTIM'S EMAIL*
VEHICLE INFORMATION- IF APPLICABLE
YEAR OF VEHICLE
MAKE OF VEHICLE
MODEL
BODY STYLE
COLOR
LICENSE PLATE NUMBER
STATE
VIN NUMBER
VEHICLE USAGE:
Object of attack, suspect vehicle, used in the offense, etc...
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Step Four

PROPERTY INFORMATION
Please list all property that was removed. EX: 1 Motorola Cell Phone Charger valued at approximately $30. 1 Apple IPhone serial number ABC123 valued at $600... If you can supply, please list the serial number of the item with the description.
LIST THE PROPERTY THAT WAS STOLEN OR LOST.
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Step Five

DAMAGE INFORMATION
PLEASE LIST HOW THE DAMAGE HAPPENED
Explain what type of damage was incurred, if applicable. For example, House window smashed by a rock.
TARGET OF THE DAMAGE
Explain where and what was the target of damage, if applicable. For example, My house, window smashed.
Tell us What Happened:*
Describe in exact detail what happened. The more information the better.
Attach
Please attach any photograph(s) of the damaged property if applicable.
Attach
Please provide additional photo if applicable.
Attach
Please provide any video evidence if applicable.
YOUR SIGNATURE
Sign the report when complete. An unsigned report will not be accepted or recorded. Anyone who knowingly submits a report containing false information is subject to arrest and prosecution. Your submission of the below information will be electronic proof of your filing of this report. ONLY THE POLICE DEPARTMENT WILL HAVE ACCESS TO THIS INFORMATION as proof of filing.
First Name*
Last Name*
LAST FOUR OF YOUR SSN OR DLN *
A department representative will either call you or email you with the police report number. If further follow up will be required, an officer will be in contact with you.

Leave This Blank:

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

This field is not part of the form submission.
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Rolling Meadows Police Department-ONLINE REPORTING FORM

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