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Theft from a Motor Vehicle

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)

   (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 to report theft from a motor vehicle.

8. Reporting Party

10. First Name*

11. Middle Initial

12. Last Name*

13. Suffix

15. Address*

17. City*

18. State*

19. Zip*

21. Date of Birth*
    Date of Birth

22. Sex*
    -- Select One --FemaleMale

23. Race*
    -- Select One --AsianBlack or African AmericanAmerican Indian or Alaska NativeNative Hawaiian or other Pacific IslandUnknownWhite

24. Ethnicity*
    -- Select One --Hispanic OriginNot of Hispanic Origin Unknown

26. Phone Number*

27. Email Address*

28. Preferred method of communication*

    1. Email
    2. Telephone

32. Incident Information

34. Location of incident if different then reporting party address

36. Date and Time of Incident
    Date and Time of Incident

    Date and Time of Incident

    Approximate if unknown

38. Vehicle Information

40. Make*

41. Model*

42. Year*

43. Color*

45. State Registered*

46. Plate Number*

47. VIN*

49. Was Vehicle Locked?*

    1. Yes
    2. No

51. Property Information

53. Description of stolen items. (If nothing was taken, type NONE)

    Be as descriptive as possible, i.e. make, model, color, serial number, value

55. Images or supporting documents

59. 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).

    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).

61. First and Last name*

62. Date Signed*
    Date Signed

Leave This Blank:


64. 1. Receive an email copy of this form.
65. Email address

    This field is not part of the form submission.

66. Submit

* indicates a required field