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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 the form below for retail theft only:
8. Business Name*
10. Address*
12. City
13. State
14. Zip
16. Phone Number*
17. Email
18. Preferred method of communication*

    1. Email
    2. Telephone
20. Name of Reporting Party*
21. Title of reporting Party*
23. Date of Birth*
    Date of Birth
24. Sex*
    -- Select One --FemaleMale
25. Race*
    -- Select One --AsianBlack or African AmericanAmerican Indian or Alaska NativeNative Hawaiian or other Pacific IslandUnknownWhite
26. Ethnicity*
    -- Select One --Hispanic OriginNot of Hispanic Origin Unknown
30. Date and Time of Theft*
    Date and Time of Theft

    Date and Time of Theft
31. Total Value of Theft*
33. Description of Stolen Items with Individual Values*
    Be as descriptive as possible, i.e. make, model, color, serial number, value
35. Suspect Information and Description (Name if known)*
37. Pictures, Video or Supporting Documents
39. Additional details (optional)
43. 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).
45. First and Last name*
46. Date Signed*
    Date Signed
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field