Collierville Police Department Traffic Complaint Form

Collierville Police Department
Narcotic Complaint Form

Use this form to report narcotics activity or drug dealers that you observe in the Town of Collierville. The information you provide will help the Collierville Police Department successfully respond to the problem of drug trafficking in your community. Please be observant and complete as much of the form as possible. You may submit this form as often as is necessary.

The information you submit will be forwarded to the Special Enforcement Unit for further investigation and enforcement. Investigators from this unit may contact you for additional information if you elect to provide your name in the space provided below. If you elect to remain anonymous, however, be assured that the information you provide will be acted upon.

In any case, all information will be held in STRICT CONFIDENCE.

Thank you for helping us help you.

Narcotic Information
(Please use the tab button to advance from one field to the next, hitting return automatically submits the form.)

EXACT street address where dealing occurs:

check all that apply:

on street	rear driveway	from vehicle
inside premises	other

If other, describe:

Where are drugs hidden?:

Have you seen guns at this location?:

[ Yes ]

Are there dogs inside these premises?:

[ Yes ]

Are the doors reinforced or gated?:

[ Yes ]

Are the windows reinforced or gated?:

[ Yes ]

Describe how the drug sale occurs::

Drug Activity

Hours of the day with HEAVIEST traffic:

Indicate a.m. or p.m.

Day of week:

with HEAVIEST traffic

Drug Activity Nature

Primary Drug:

If other, please describe::

Vehicles Used

Manufacturer:

Model Name:

Vehicle Color:

License State:

License Number:

Unique Features:

Dealer Identity

Dealer First Name:

Dealer Last Name:

Dealer Nickname:

Dealer Age:

Dealer Race:

Dealer Sex:

Unique Features:

Dealer Address:

Dealer Phone:

Dealer Other Phone:

Your Information

This information is optional. Your confidentiality is assured. It will only be used by us if we have any questions.

Your First Name:

Your Last Name:

Your Address:

Daytime phone:

e-mail: