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2. If you need immediate assistance, please call the main number at 860-886-5561 Ext. 6. If this is an emergency, please call 911. If you wish to report activity that is on-going and does not require immediate attention, please complete the form below.
   (Warning: Internet IP addresses are captured when submitting this form. Intentionally completing a form with false information can result in a criminal investigation)
6. Please complete a general report:
8. First Name*
9. Middle Initial
10. Last Name*
11. Suffix
13. Date of Birth*
    Date of Birth
14. Sex*
    -- Select One --FemaleMale
15. Race*
    -- Select One --AsianBlack or African AmericanAmerican Indian or Alaska NativeNative Hawaiian or other Pacific IslandUnknownWhite
16. Ethnicity*
    -- Select One --Hispanic OriginNot of Hispanic Origin Unknown
18. Address*
20. City*
21. State*
22. Zip*
24. Phone Number*
25. Email*
27. Preferred method of communication*

    1. Email
    2. Telephone
31. Type of Incident*
    -- Select One --LarcenyPublic HazardParkingNarcotic Activity
33. Address of Incident*
35. City
36. State
37. Zip
39. Describe Incident or Request in Detail:*
41. Supporting images or documents:
45. By completing this form, I certify that the information contained herin is true, correct, and complete to the best of my knowledge and belief. I further acknowledge that any intentional false statement or misstatement may be a violation of 53a-180c.
    Please type your name below for the purpose of electronically signing this report (CT Sec. 1-272. Legal recognition of electronic records, electronic signatures and electronic contracts).
47. First and Last name*
48. Date Signed*
    Date Signed
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field