Rolling Meadows, IL - Official Website

Step One

Please read the following information to know 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 or annoying (Caller may be known, and you desire no follow up by police) ACCIDENTAL DAMAGE:Damage reported that was unintentional. LOST LICENSE PLATE: License plate missing from vehicle unknown if stolen or not. SUPPLEMENTAL REPORT: An additional report that needs to be filed from one that you completed earlier on a previous report.
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 or annoying (Caller may be known, and you desire no follow up by police) ACCIDENTAL DAMAGE:Damage reported that was unintentional. LOST LICENSE PLATE: License plate missing from vehicle unknown if stolen or not. SUPPLEMENTAL REPORT: An additional report that needs to be filed from one that you completed earlier on a previous report.
REPORT NUMBER
Police Department will provide when filed
CHECK THE TYPE OF INCIDENT:*
1. Theft from Auto
2. Lost Property
3. Damage to Auto
1. Bicycle Theft
2. Gasoline Theft
3. Matter of Record
1. Phone Harassment
2. Accidental Damage
1. Lost License Plate
2. Supplemental Report
YOUR INFORMATION
First Name*
Last Name*
YOUR BIRTHDAY*
SEX*
1. Male
1. Female
Address1*
Address2
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*
Last Name*
DATE OF BIRTH*
SEX*
1. Male
1. Female
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 serial number of item with description.
LIST PROPERTY THAT WAS STOLEN OR LOST.
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Step Five

DAMAGE INFORMATION
PLEASE LIST MEANS OF DAMAGE
Explain what type of damage was done, if applicable
TARGET OF DAMAGE
Explain where and what was the target of damage, if applicable.
Tell us What Happened:*
Complete a narrative of what occurred.
Attach
Please attach any photograph of property if applicable
Attach
Please provide additional photo if applicable
Attach
Please provide any video 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.

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

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Rolling Meadows Police Department-ONLINE REPORTING FORM

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