CHAMPAIGN POLICE DEPARTMENT
82 E. University Ave. Champaign IL, 61820; Phone (217) 351-4545
OFFICIAL POLICE REPORT
This report may be presented in person or mailed to the
Champaign Police Department, Attn: B.J.Meyers. Do not fax.
GEO-Code: Case Number:
Badge: Rpt Received By:
Time Received: Date Received:
Identity Theft Information Provided Online
Type of Occurrence:
THEFT UNDER $500.00(0820) THEFT OVER $500.00(0810) LOST PROPERTY(9061)
CRIMINAL DAMAGE (1310) LOST DRIVERS LIC/PLATE (9063) OTHER
Address of Occurrence:
Location type: Street (304) Apartment (090) Lot (096) House (290) Business (140) Lot(278) Bar (103) Driveway (176)
Time Frame of Occurrence:
Start Date: / / Time: End Date: / / Time:
Reporting Person/Victim: , ,
Last First Middle
Date of Birth: / / Race: Sex: M F Hair
Month Day Year Height Weight Eye_________
Driver’s License Number: State Issued: Soc Sec: - -
Email address: __________________________________________
Permanent Address:
Street Apt City State Zip
Permanent Phone Number: - - Cell Phone Number: - -
Local Address:
Street Apt City State Zip
Local Phone Number: - - School:
Employer: Phone Number: - -
Address: ______________________________________
Bicycle Information- IF applicable (480) LEADS #
COLOR MAKE MODEL SPEED
FRAME SIZE WHEEL SIZE STYLE LOCKED Y/N
SERIAL NUMBER AGENCY/CITY REGISTERED
IDENTIFING MARKS REGISTRATION NUMBER
VALUE $
Cell Phone Information- IF applicable (489) LEADS#
COLOR MAKE MODEL TYPE
SERIAL NUMBER PHONE NUMBER
CARRIER CARRYING CASE Y/N VALUE $
Purse/Wallet Information- IF applicable (740)
BRAND COLOR DESIGN/LOGO
MATERIAL FEATURES (bifold/zip top/etc)
OTHER IDENTIFIERS VALUE $
Missing Items/Contents- IF applicable LEADS #
Drivers License (557) Y/N State Issued License Number
State ID (647) Y/N State Issued ID Number
Social Security (647) Y/N Passport (647) Y/N Birth Certificate (647) Y/N
School ID(647) Y/N School Issued
University Of IL ID(647) Y/N Parkland ID (647) Y/N US Currency (550) Y/N Value $
Other Currency (550) Y/N Country Value $
Checks/Credit/Debit Cards
Credit Card (541) Financial Institution Issued Cancelled
Y N
Y N
Y N
Y N
Y N
Check (492) Numbers Y N
Articles- IF applicable
Item Description Value
$
$
$
$
Vehicle Information- IF applicable LEADS #
YEAR MAKE MODEL COLOR
PASSENGER CAR(821) TRUCK(831) VAN /SUV (833) OTHER
PLATE STATE VIN
Missing Plate(s)(679) BOTH FRONT REAR Value $
Damage to: Hood Trunk Door Window Antenna Mirror Hitch/Bumper
Owner if not same as above: , ,
Last First Middle
Date of Birth: / / Social Security: - - Sex: M / F
Month Day Year Race:
Address:
Street Apt City State Zip
*NOTE: It is the recommendation of the Champaign Police Department that you cancel all credit/debit cards along with checking accounts and notify your financial institutions of your loss.
Please complete a short narrative with information on the situation surrounding the incident you are reporting.
Signature of reporting person/victim ________________________________Date____________________________
Instructions for completing and filing your Police Report
Please make sure that when you are filling out your report you complete every blank that pertains to the event you are reporting.
In order to file your report with our department, we are required to ask you for your personal information, which includes:
· Your Address and Phone number
· Your Date of Birth
· Your Race/Sex, Hair/Eye color
· Your Employer’s name, address, & phone number
· Name of School (If you are a student)
· Your Vehicle, Bicycle, Cell Phone, Purse or Wallet information if applicable.
It is very important for you to include serial and model numbers of any items you report as lost or stolen.
It is also important for you to include your estimated value of any items you are reporting lost, stolen, or damaged.
If you have any questions about completing your report form you may contact the Champaign Police Department at 217-351-4545 and speak to a Police Services Representative for assistance.
When your report is completed you may either mail the form back to the Police Department at:
82 E. University Avenue, Champaign, IL 61820 Attn: B.J. Meyers, or drop off the form at the Front Desk of the police department which is open 24 hours a day, 7 days a week.
WE RECOMMEND THAT YOU DO NOT EMAIL YOUR COMPLETED REPORT BACK TO THE POLICE DEPARTMENT. THE EMAIL ACCOUNT IS NOT ENCRYPTED.
Police Department • 82 E. University • Champaign IL 61820 • (217) 351-4545 • fax (217) 403-6904 • www.ci.champaign.il.us
IDENTITY THEFT ACTION STEPS
If you think that you are a victim of fraud, call your credit card issuers to close or “flag” your accounts, and call your bank to put an alert on your checking accounts.
If your social security number was used fraudulently, report the problem to the Social Security Administration’s Fraud Hotline at 1-800-269-0271.
Contact the Federal Trade Commission at www.FTC.GOV to file a complaint, and receive additional forms and affidavit assistance. (1-877-ID-Theft) You are also entitled to a free yearly credit report, go to www.annualcreditreport.com The FTC will have the most up-to-date information on the current contact information for the Credit Bureaus.
Credit Bureaus: Call the fraud units of each of the three major credit bureaus to report all fraudulent transactions of which you are aware. Order a copy of your credit report from each, and instruct each credit bureau to put a “Fraud Alert” and statement on your information asking that creditors call you first before verifying any new credit applications. Do this by phone AND IN WRITING.
TransUnion: www.tuc.com TransUnion, PO Box 6790, Fullerton, CA 92634: (800) 680-7289
Equifax: www.equifax.com Equifax Information Services LLC, PO Box 105069 Atlanta, GA 30348-5069 (800) 685-1111
Experian: www.experian.com Experian, PO Box 9530, Allen, TX 75013: (800) 379-3742
Have all three of the credit bureaus run a credit report , and have it mailed to you. Compare the information on your report with what you know is legitimate.
Contact the Consumer Credit Counseling Service at 1-800-388-2227 for help in clearing false claims from your credit report.
Creditors: Contact all creditors with whom your name has been used fraudulently, by phone, and in writing, to inform them of the identity theft.
If your name, date of birth, and/or social security number has been used fraudulently, you will need to file the appropriate reports with the police departments in the jurisdiction that the crime occurred. If the identity theft involves the mail, you will also want to contact the local U.S. Postal Inspectors office.
And in Illinois, you can also contact the Illinois Attorney General’s ID Theft hotline at 1-866-999-5630 for further assistance.
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