Section 1 of 5 in this document

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Hazlet Township Police Department

Theft under $200 Form

What is the Dollar Amount of the Theft?

STOP! Do not Fill out this form

Please go to your local Police HQ

Where did the theft occur?

Hazlet Township

A different jurisdiction

STOP

Please file report in town where theft occurred.

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Section 2 of 5 in this document

Is this Report for an Individual or Business

Date of Birth

Driver License Number

Driver License State

Phone Number

Business Name

Business Phone Number

Primary Contact Phone Number

Extension

Section 3 of 5 in this document

Date when Theft Occurred:

Between: *

And: *

Time frame when Theft Occurred:

Between: *

And: *

Can you list the property items that were taken?

Item 1

Item 1 - Type

If "other" list item

Item 1- Brand

Item 1- Model

Item 1- Color

Item 1- Serial #

Item 1- Quantity

Item 1- Value of Item

Do you need to add another item?

Yes

Item 2

Item 2 - Type

If "other" list item

Item 2- Brand

Item 2- Model

Item 2- Color

Item 2- Serial #

Item 2- Quantity

Item 2- Value of Item

Do you need to add another item?

Yes

Item 3

Item 3 - Type

If "other" list item

Item 3- Brand

Item 3- Model

Item 3- Color

Item 3- Serial #

Item 3- Quantity

Item 3- Value of Item

Section 4 of 5 in this document

Do you know of a Suspect?

Yes

Suspect's Phone Number

Narrative

Please enter in a narrative to describe the event(s)

I certify this report to be truthful with all accurate information to the best of my knowledge.

First Name

Last Name

Choose how to sign

Draw Type

By checking this box, I understand filing a false police report is a crime. Any person who gives or causes to be given false information to any law enforcement officer, with respect to the commission of any crime or incident, is guilty of a fourth degree crime under the New Jersey Code of Criminal Justice (2C:28-4). Fourth degree crimes are punishable by a fine of not more than $ 1,000.00, or by imprisonment for not more than 18 months, or both.

Receipt

You will be provided with a Receipt upon submission.

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Hazlet Township Police Department

Theft under $200 Form

Where did the theft occur?

Full Name

Business Address

Primary Contact for Business

Address of Theft

Date when Theft Occurred:

Time frame when Theft Occurred:

Item 1

Do you need to add another item?

Item 2

Do you need to add another item?

Item 3

Do you know of a Suspect?

Suspect's Full Name

Suspect's Full Address

Narrative

I certify this report to be truthful with all accurate information to the best of my knowledge.

Receipt