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File a Police Report

2. Important Notice
   Arkansas Code 5-54-122: Filing false report with a law enforcement agency. Report means any communication, either written or oral, sworn or unsworn.

   Arkansas Code 5-54-122: Filing false report with a law enforcement agency. Report means any communication, either written or oral, sworn or unsworn.

4. Offense*
   -- Select One --Criminal MischiefHarassmentIdentity TheftShopliftingTheftTheft of Motor FuelUnsightly ConditionsInterference with Child Custody

   This is a Required Field. Please Choose an offense. For details see Offense Descriptions.

5. Offense Descriptions
   View offense documents.

7. Date / Time the Offense Occurred*
   Date / Time the Offense Occurred

   Date / Time the Offense Occurred

   Required

8. Address / Location Where the Offense Occurred*

   Address / Location must be within the City Limits of Blytheville AR.

12. Your Name*

    Required

14. Your Date of Birth*
    Your Date of Birth

    Required

15. Race*
    -- Select One --WhiteBlackAsianNative AmericanNative Pacific Islander

    Required

16. Gender*
    -- Select One --MaleFemale

    Required

17. Ethnicity*
    -- Select One --YesNo

    Hispanic

19. Your Address*

    Required

21. City*

    Required

22. State*

    Required

23. Zip

25. Your E-Mail Address

26. Your Phone Number

28. Business Name (If Involved)

29. Phone Number

31. Street Address

33. City

34. State

35. Zip

39. Witness / Suspect
    -- Select One --WitnessSuspectOffender

40. Name

    If Known

42. Date of Birth
    Date of Birth

    If Known

43. Race
    -- Select One --WhiteBlackAsianPacific Islander

    If Known

44. Gender
    -- Select One --MaleFemale

    If Known

45. Phone Number

    If Known

47. Street Address

49. City

50. State

51. Zip

53. Witness / Suspect
    -- Select One --WitnessSuspectOffender

54. Name

56. Date of Birth
    Date of Birth

    If Known

57. Race
    -- Select One --WhiteBlackAsianPacific Islander

    If Known

58. Gender
    -- Select One --MaleFemale

    If Known

59. Phone Number

61. Street Address

63. City

64. State

65. Zip

69. Property
    -- Select One --DamagedStolen

70. Property Description

71. Serial Number

72. Value

74. Property
    -- Select One --DamagedStolen

75. Property Description

76. Serial Number

77. Value

79. Narrative*

    Required

Leave This Blank:


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

    This field is not part of the form submission.

82. Submit

* indicates a required field