1.)  Please describe the drug problem you are encountering?

 2.)  When is this occurring?    Day:    Night:          Time:

 3.)  Day(s) of the week this is occurring: 

 4.)  Can you be specific on the location where this is occurring? (Address?)

 5.)  Do you know the name(s) of the the person(s) involved?  Please include their "street" 

        or nickname.  Can you describe them? (Race, Sex, Height, Weight, Hair Color, Approximate

        Age)

 6.) If known, please list the pager number, cell phone number, or home phone number of the

         subject(s) involved in this activity.

 7.) Are there any vehicles being used or involved? Do you know their tag number or vehicle description?    (Car, Truck, etc./Color/Make/Model/Year/2-door or 4-door)

 8.) Can we contact you?

Name
E-mail
Telephone
FAX

Please contact me as soon as possible regarding this matter.