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PALM SPRINGS POLICE DEPARTMENT - 3311
200 SOUTH CIVIC DR., PALM SPRINGS, CA 92262
(760) 323-8116
Special Instructions:

Please do not complete this form if you have information on a suspect who committed the crime. You must contact the Police Department directly to file a report.

Please note that indicates required field. These must be completed or the server will reject your report. If you need additional assistance in completing this report, simply click on the HYPERLINKS and more instructions will follow. It is recommended that you print out the instructions form so you have them available as you fill in this form.

Do not Print out this form and mail it into the Police Department. The form must be filled out online and entered with the submit button below. If you mail in the Report it will be rejected.

This is a secure form. The information will only be reviewed by the Palm Springs Police Department Personnel.


Victims' Bill of Rights - Marsy's Law - Click here for information

After you submit this report to the Palm Springs Police Department, it will be reviewed by the staff and forwarded to the appropriate location. Once reviewed, you will receive an e-mail advising you of the file number assigned to your report. Please do not call and ask about the status of your report. If an officer or other staff member needs to contact you, they will do so. You can only report crimes or incidents that occurred in the CITY of PALM SPRINGS with this form.

Thank you.
VICTIM'S INFORMATION
Victim's Name:
Victim's Address:
City: State: Zip:
What ethnicity is the victim?
Is the victim male or female?      Victims Date of Birth:     month/day/year
Victim's Home Phone:   ex. 999-999-9999
Victim's Business Phone:   ex. 999-999-9999
Victim's drivers license number:   State
Additional Victim or Other:
Additional Information
INCIDENT INFORMATION
Incident occurred in Palm Springs? Yes No
What type of crime are you reporting?
   What is the address or location where this incident occurred? 
 What is the cross street where this incident occurred?
   When did this incident occur (month/day/year)?   Between and 
   Time of incident?   Between   and 
The premise type where this incident occurred was:
If other, specify:
Vehicle Information
Was there a vehicle involved? Yes No
What is the type vehicle involved?
What is the make of the vehicle involved?
What is the model of the vehicle involved?
What is the year of the vehicle involved?
What is the color of the vehicle involved?
Involved vehicle license plate number?     State:
Was the vehicle locked?
What type of vandalism occurred?
What was the point of entry?
What was the method of entry?
What was the location of entry?
Where was the victim at the time of this incident?
   Please provide a brief summary of the incident:
Property Information
Describe what was:
Description of property (see instruction page for format):
ARTICLE NAME QTY BRAND/NAME SERIAL NUMBER MISC. DESCRIPTION VALUE
What is the total value of all items (described above)?
REPORTING INFORMATION
Please enter your name as you would sign your signature:
What is your E-Mail address?
Please enter the date of this report (month/day/year):

By submitting this report you are certifying that the information provided is true and correct to the best of your knowledge. Remember it is a misdemeanor to make a false report of a crime (Sec. 148.5 Calif. Penal Code).