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Please read the form instructions prior to use

lease include as much information as you can in the form below. Incomplete or inaccurate information will delay processing of this report and may compromise our ability to quickly and effectively respond to this complaint.

Indicates that this field is required and must be completed for the form to be processed. While this form is lengthy, not all areas will apply to every report. Please remember, if you were reporting this to a police officer you would invariably be asked to provide this information. That is why we ask you to go through the pains of providing it on this form. Quite simply, it's because we need it.

Location & Description of Activity The address must be entered correctly for the report to be processed and sent to the correct district. Incorrect, misspelled or incomplete data will return a negative response and cannot be processed.   Select your district from the pull-down list. If you do not know your district, view the district map and find the district that covers your address. Patrol District: select from list 1st District 2nd District 3rd District 4th District 5th District 6th District 7th District 8th District 9th District 12th District 14th District 15th District 16th District 17th District 18th District 19th District 22nd District 23rd District 24th District 25th District 26th District 35th District 39th District 92nd District Center City District   If the activity occurs inside a business or nightclub, please tell us the name of the property. Property Name : Only enter the numerical address number in this space. Street Number:   Select your street direction here. If there is no direction, select "Not Applicable". Street Direction: select from list Not Applicable N S E W   Enter only the street name here. For example: enter "Roosevelt" (without the quotes) if you live on Roosevelt Boulevard. DO NOT enter the street type. Street Name:   Select the street type from the list provided. If the street type isn't on the list, please contact the webmaster so the form can be updated. Street Type: you must select one Alley Avenue Boulevard Court Circle Drive Expressway Highway Lane Parkway Pike Place Plaza Road Run Square Street Terrace Trail Way   If the activity is inside an apartment, please give us the number.   Apartment Number :     Please check the appropriate box If the violation location meets one these conditions.   Violation Proximity: next door to an elderly resident next door to a handicapped resident near a school or place of worship near a playground or recreation center       Please select where the activity occurs at this location: Select the location that applies to the violation you are reporting.   Identify the activity location for this violation - select only one   Inside Business Inside Private Residence Alley or Driveway Hallway - Corridor Park—Wooded Area Sidewalk—Street Corner Vacant Lot Car—Truck—Motorcycle Garage Other If "Other" Please Identify:     Please tell us about the security at this location: Help us determine what we're up against so we can take the necessary precautions. If you don't know the answer, leave it blank. Do not guess or assume. Have you seen guns at this location? Yes No Are there dogs inside this location? Yes No Are the doors reinforced or gated? Yes No Are the windows reinforced or gated? Yes No       Please tell us about the activity: Complete the areas below to acquaint us with the type of drug activity you are reporting and when it occurs.   Drug being sold: Select From List Crack Cocaine Cocaine-Powder Heroin Ice/Methamphetamine LSD Marijuana PCP/Angel Dust Other     If the drug being sold was not on the list, please tell us what it is in this field.   If "Other" Please Identify:     Tell us the days when the activity is most pronounced. Select all that apply. DO NOT EXAGGERATE. We will be using this information to verify the report.   Days when activity is present?: Monday Friday   Tuesday Saturday   Wednesday Sunday   Thursday All Week       Don't Know     Tell us the times when the activity is most pronounced. Select all that apply. DO NOT EXAGGERATE.   Time when activity is present?: 12 AM — 2 AM 2 PM — 4 PM   2 AM — 4 AM 4 PM — 6 PM   4 AM — 6 AM 6 PM — 8 PM   6 AM — 8 AM 8 PM — 10 PM   8 AM — 10 AM 10 PM — 12 AM   10 AM — 12 Noon Infrequently   12 Noon — 2 PM 24 Hrs a Day       Don't Know     Use this space to tell us about the activity. Explain as much as possible about the dealing you are reporting. This is the area where you tell us everything you know. You can't tell us too much!   Describe the Activity:   Please tell us about the drug dealer or distributor: If you know the drug dealer's name, description, current address or phone number, please provide it bellow.     If you know the dealer's name please provide it below.   Dealer's Name:     If you know the dealer's nickname please provide it below.   Dealer's Nickname:     Enter the approximate age of the primary drug dealer at this location. You may enter an age range. i.e.: 20-25 years.   Dealer's Age:     Select the primary dealer's race and sex from the drop down list.   Dealer's Race & Sex: Select From List Asian Male Black Male Hispanic Male White Male Other Male Unknown Male Asian Female Black Female Hispanic Female White Female Other Female Unknown Female   If you know the dealer's name please provide it below.   Dealer's Phone:     If you know the dealer's pager number please provide it below.   Dealer's Pager:   If you know the violator's address please provide it below.   Dealer's Address:   If you know the dealer's city, state & zip please provide it below.   City-State-Zip:     Please describe the violator's appearance. Include scars, tattoos, clothes, jewelry descriptions, hair styles and any other distinguishing marks. If you can't provide a description, enter "Unknown" in this space.   Dealer Description :         Please tell us about any vehicles used by the dealers: Use this area to tell us about any vehicles used by the drug dealer and those who deliver drugs to this location. If there is more than one vehicle used, submit this form and then hit your browser's "BACK" button. The original report will be displayed again so you can re-submit it again with a different vehicle description. The info you submitted previously will still be on the form so you won't have to re-type it. Just change the car information.     An approximate model year is fine if you know it. If the car is a newer model, say that. If it's a beat-up old wreck, tell us that.   Vehicle Year:     For example: Ford, Toyota, Chevrolet, Honda, Cadillac.   Vehicle Manufacturer:     For example: Camaro, Cutlass, Camry, Grand Am.   Vehicle Model Name:     Vehicle Color   Vehicle Color :     Enter the license plate state in this box. If you don't know, tell us what color the license plate is.   License Plate State:     License Plate Number. If you only know part of it, enter it here.   License Number:     Describe any of the vehicle's unique features lile damaged parts, accessories, sun roofs, mismatched paint, etc. The idea is to give us a unique description of the car so we'll immediately recognize it.   Unique Features:         Your Information This area is completely optional. You do not have to provide this information to us. It will only be used if we need to contact you for additional information and will be kept strictly confidential. Your Name: Your Street Address: (no P.O. Boxes) Apartment Number: City & State: Zip Code: Daytime Phone: May we call you? Yes No Your E-mail : Additional Comments:   When you click "Submit" the information you provided will automatically be routed to the Philadelphia Police Department's Narcotics Division.   Important Disclaimer: Communications made through this electronic mail and message system shall in no way be deemed to constitute legal notice to the City of Philadelphia, the Philadelphia Police Department or any of its agencies, officers, employees, agents, or representatives, with respect to any existing or potential claim or cause of action against the City or any of its agencies, officers, employees, agents, or representatives, where notice to the city is required by any federal, state or local laws, rules or regulations.

Information listed here is believed to be current at the time of publication. However, some of the material presented here may have expired since it was posted. Persons should contact a Philadelphia Police representative whenever relying on dated material or information that is subject to change.

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