2. Choose From the Following

   1. This is an emergency
   2. The incident is still happening at this time
   3. There is a crime scene or other physical evidence
   4. The incident occurred outside the Town of Middleton
   5. You know who the suspect is
4. Name*
5. Email Address*
6. Date of Birth
   Date of Birth
8. Address*
10. City*
11. State*
12. Zip Code*
14. Phone Number
15. Secondary Phone or Email Address
17. When Did Incident Occur*
18. Where Did Incident Occur*
20. What Time Can We Contact You
    What Time Can We Contact You Start Time

    —

    What Time Can We Contact You End Time
22. Type of Crime

    1. Bicycle Theft or Other Theft
    2. Theft from a Motor Vehicle
    3. Hate Crime
    4. Lost Property

    1. Harassing Phone Calls
    2. Vandalism
    3. Noise Complaint
24. I understand that it is a misdemeanor to make a false report of a crime, punishable by fines up to $500 and imprisonment of one year in a House of Corrections (MGL c269 s13A)

    1. I Acknowledge the Above Statement
    2. I Do Not Acknowledge the Above Statement
26. Are You

    1. The Victim
    2. Reporting on Behalf of Someone Else
    3. A Witness
28. If Reporting on Behalf of Someone Else, Please Indicate the Person You Are Reporting for
30. First Name
31. Last Name
33. Address
35. City
36. State
37. Zip Code
39. Phone Number
40. Gender

    1. Male
    2. Female
41. Date of Birth
    Date of Birth
43. Enter property and/or vehicle Information for Item Number 1
45. Enter property and/or vehicle Information for Item Number 2
47. If a Vehicle Was Involved Involvement Type

    1. Theft From
    2. Damaged
    3. Suspect Vehicle
49. Vehicle Description - Indicate for Each Category
51. Make
52. Model
54. Color
55. Registration Number & State
57. Provide Any Other Additional Information
59. Please Note
    You will be contacted by an investigating officer within 72 hours.
Leave This Blank:


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

    This field is not part of the form submission.

63. Submit

* indicates a required field