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2. Victim Type
4. Is the victim of the crime that you are reporting a person or a business?

   1. Business

   1. Person
6. Victim's Name
8. Victim's Address
10. Victim's Phone Number
12. Your Information
14. Name*
15. Date of Birth*
17. Address*
18. City*
20. State*
21. Zip*
23. Home Phone Number*
24. Cell Phone Number
26. Email Address
28. Incident Information
30. Incident Type*
    -- Select One --Lost PropertyDamage to PropertyVandalism ReportTheft from Vehicle
32. Date and Time of Incident*
34. Estimated Dollar Value of Damages/Loss*
36. Incident Location
38. Description of Property*
    Please be concise. Describe property lost, taken or damaged.
40. Description of Incident
    Please be concise.
42. Confirm Online Police Report
    I understand that I am filing this report for information / insurance purposes only.
    I understand that filing this report shows that there are no known suspects.
    I understand that no follow-up investigation will be conducted by the Chesterton Police Department.
    I understand that filing a false police report is a crime punishable by law.
    I hereby certify that this report is true and correct to the best of my knowledge.
44. 1. I agree to the above terms and conditions.
46. Electronic Signature*
    First Name, Middle Initial, Last Name
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field