ILLEGAL DRUG ACTIVITY REPORT FORM

Illegal Drug Activity Report Form

Use this form to report narcotics activity and drug dealers that you observe in your Peoria, Illinois neighborhood. The information you provide will help the Peoria Police Department successfully respond to the problem of drug trafficking in our community. Please be observant and complete as much of the form as possible. You may call and use this form to provide information which assist us.

The information you submit will be routed to the appropriate unit and/or patrol district. They, in turn, will notify other units and agencies as required to insure that a coordinated plan of action is initiated. If you have provided us with contact information, officers from these units may wish to contact you for additional information.

Please note that you may remain anonymous. However, if you choose to do so we will be hampered in our ability to elicit additional information from you that we may require to adequately respond to this report. Nevertheless, if you choose to remain anonymous you can be assured that the information you provide will be acted upon.

If you elect to provide us with your identity, you have our assurance that we will treat it as confidential information and will not disclose it outside this agency except as required and permitted by law.

Please include as much information as you can in the form below. Incomplete or inaccurate information will delay processing of this report and may compromise our ability to quickly and effectively respond to this complaint.

If in Peoria you may call 309-673-4521; fill out and submit this form below; or e-mail us at peoriapd@peoriagov.org. Please include all required data and as much additional information as you can in the form below. Incomplete or inaccurate information will delay processing of this report and may compromise our ability to quickly and effectively respond to this complaint.

Please read the following paragraphs:
The information I’ve provided on this form is correct to the best of my knowledge. I understand that providing false information could make me subject to fine, imprisonment, or both under State of Illinois Law.

Complaints filed via this web site are processed and may be referred to other law enforcement/regulatory agencies for possible investigation. Any investigation opened on complaints filed on this web site is opened at the discretion of the Peoria Police Department.

Advisory:
You are about to file a complaint with the Peoria Police Department. The confidentiality of the information you provide may be affected depending on state law. As such, we cannot guarantee that your complaint will remain confidential. Submitting the form indicates that you understand this.

* indicates required field

Please tell us about the location.
As many details as you may provide will be helpful. If the activity occurs inside a business or nightclub, please tell us the name of the property.

Property Name:

Street Number:

Street Direction:

Select from a Direction North Northeast East Southeast South Southwest West Northwest

Street Name:

Apartment Name:

Peoria IL:

61601 61602 61603 61604 61605 61606 61614 61615

Street Name/Corner:

Violation Proximity:

Please check the appropriate box if the violation location meets any of these conditions.

Near a school
Next door to elderly resident
Next to a place of worship
Near a playground or rec. center
Street corner
Inside a business
Inside a private residence
Alley or driveway
Hallway or corridor
Park or wooded area
Vacant Lot
Garage
Other:

Describe:

Motor Vehicle (complete information below)

Drug Dealer Vehicle Information:
Use this area to tell us about any vehicles used by the drug dealer and to deliver drugs to this location.

Vehicle Make:

Cadillac Chevrolet Dodge Ford Honda Mitsubishi Toyota Volkswagen Other

Vehicle Model: (For Example: Eldorado, Camaro, Cutlass)

Vehicle Color:

Year:

License Plate:

State:

Other/More Details:

Please tell us about the security at this location:
Help us determine what we're up against so we can take the necessary precautions. If you don't know the answer, leave it blank. Do not guess or assume.

I have seen guns at this location.

There are dogs inside this location.

The doors are reinforced or gated.

There are cameras or alarms at this location.

There are windows reinforced or gated.

Further information:

If any boxes IN THIS AREA are checked, please provide more details and information.

Please tell us about the activity:
Complete the areas below to acquaint us with the type of drug activity you are reporting and when it occurs.

Drug being sold:

Select from list Crack Cocaine Cocaine-Powder Heroin Ice/Methamphetamine LSD Marijuana PCP/Angel Dust Other/Multiple

If the drug being sold was not on the list, please tell us what it is in this field.

If \"Other\" please identify:

Tell us the days when the activity is most pronounced. Select all that apply.

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
All week
Don't know

DO NOT EXAGGERATE. We will be using this information to verify the report.

Tell us the times when the activity is most pronounced. Select all that apply.

12AM - 2AM
2AM - 4AM
4AM - 6AM
6AM - 8AM
8AM - 10AM
10AM - 12 Noon
12 Noon - 2PM
2PM - 4PM
4PM - 6PM
6PM - 8PM
8PM - 10PM
10PM - 12AM
Infrequently
24 hours a day
Not sure

Describe the activity:

Use this space to tell us about the activity. Explain as much as possible about the dealing you are reporting. This is the area where you tell us everything you know. You can't tell us too much!

Please tell us about the drug dealer or distributor:
If you know the drug dealer's name, description, current address or phone number, please provide it below.

Dealer\'s Name:

Dealer\'s Nickname:

Dealer\'s Approx. Age/Age Range:

Dealer's Race & Sex:

Select From List Asian Male Black Male Hispanic Male White Male Other Male Unknown Male Asian Female Black Female Hispanic Female White Female Other Female Unknown Female

Dealer\'s Phone:

Dealer\'s Pager:

Dealer\'s Address:

Street, Apartment, City, State, ZIP

Dealer Description:

Please describe the violator's appearance. Include scars, tattoos, clothes, jewelry descriptions, hair styles and any other distinguishing marks. If you can't provide a description, enter "Unknown" in this space.

Important Disclaimer:
Communications made through this electronic mail and message system shall in no way be deemed to constitute legal notice to the City of Peoria, IL , the Peoria Police Department or any of its agencies, officers, employees, agents, or representatives, with respect to any existing or potential claim or cause of action against the City or any of its agencies, officers, employees, agents, or representatives, where notice to the city is required by any federal, state or local laws, rules or regulations.

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