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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 MischiefCriminal TrespassHarassmentIdentity Theft / ForgeryShopliftingTheft of PropertyTheft of Motor FuelUnsightly ConditionsInterference with Child CustodyLeaving Scene of AccidentOther

   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

13. Your Address*

    Required

15. City*

    Required

16. State*

    Required

17. Zip

19. Your Date of Birth*
    Your Date of Birth

    Required

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

    Required

21. Gender*
    -- Select One --MaleFemale

    Required

22. Ethnicity*
    -- Select One --YesNo

    Hispanic

24. Your E-Mail Address

25. Your Phone Number

27. Business Name (If Involved)

28. Business Location

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

34. Name

    If Known

35. Address

37. Date of Birth
    Date of Birth

    If Known

38. Gender
    -- Select One --MaleFemale

    If Known

39. Race
    -- Select One --WhiteBlackAsianPacific Islander

    If Known

40. Phone Number

    If Known

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

44. Name

45. Address

47. Date of Birth
    Date of Birth

    If Known

48. Gender
    -- Select One --MaleFemale

    If Known

49. Race
    -- Select One --WhiteBlackAsianPacific Islander

    If Known

50. Phone Number

54. Property
    -- Select One --DamagedStolen

55. Property Description

56. Serial Number

57. Value

59. Property
    -- Select One --DamagedStolen

60. Property Description

61. Serial Number

62. Value

64. Upload Supporting Information

    You can Upload supporting documents or photos.

66. Narrative*

    Required

Leave This Blank:


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

    This field is not part of the form submission.

70. Submit

* indicates a required field