NORTH CAROLINA AMBER ALERT FORM (Page 1 of 2)
(Please complete this form and Contact the NC Center for Missing Persons for further instruction at 1(800) 522-5437. Fax completed forms to 919-715-1682, after 5:00pm and weekends fax forms to 919-733-8134.)
Reporting Law Enforcement Agency_______________________________________________
Investigating Detective________________________Supervisor _________________________
Telephone Number______________________Facsimile Number________________________
Pager Number__________________________Cellular Number_________________________
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Date of Notification________________ Time of Notification_____________
Date of Abduction_________________ Time of Abduction______________
Location of Abduction____________________________________________________
Location Last Seen_______________________________________________________
(If different than location of abduction)
Direction of Travel_______________________________________________________
Destination______________________________________________________________
Probable________________Possible________________Unknown_______________
Vehicle Description_______________________________________________________
(Make, Model, Year, Color, License Plate Number and State of Issue)
(Indicate how reliable this information is)
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How many children were abducted? _____[For more than one child use additional page(s)]
Name_________________________________________________________________________
(Last) (First) (Middle) (Nickname)
Gender_______DOB__________Age______Race_______Skin Complexion________
Height____Weight_____Hair Color______Hair Length_____Hair Style_____Eyes__
Other Distinguishing Physical Characteristics________________________________
When Last Seen Child Was Wearing:
Shirt___________________________________________________________________ (Type, Color, Sleeve Length, Pullover, Buttoned, etc.)
AMBER ALERT FORM (Page 2 of 2)
Pants or Skirt__________________________________________________________________
Shoes/socks _____________________________________________________________
Outerwear ______________________________________________________________
In possession of __________________________________________________________
(Pet, Toy, etc.)
Other __________________________________________________________________
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How Many Abductors were there?__________[If more than one, use additional page(s)]
Name_________________________________________________________________________
(Last) (First) (Middle) (AKA)
Gender_______DOB_______Age_______Race__________Skin Complexion______________
Height_____Weight_____Hair Color______Hair Style______Hair Length_____Eyes______
Other Distinguishing Physical Characteristics_______________________________________
When Last Seen Abductor Was Wearing:
Shirt__________________________________________________________________________
Pants/Skirt____________________________________________________________________
Shoes/Socks____________________________________________________________________
Outerwear_____________________________________________________________________
Additional Identifiers____________________________________________________________
Details of
Abduction_____________________________________________________________________
______________________________________________________________________________
2/22/2011