HEAT (rev. 2011)




  ABOUT THE TIPSTER
 
Today's Date:    
  Name: 
 
Tipster's Street Address:    
Apt:    
City:      
Zip:    
County:    
  (Begin all phone numbers with area code)       
  Home Phone:   
Work Phone:    
Cell Phone:   
Pager:   
Other:   
  If Other, please specify (parent's home, friend, etc.) 
 
Okay to Contact?   
Which Number?   
Who to ask for?   
Okay to leave a message?   
If yes, which number?   
  NATURE OF ACTIVITY         
  What is the nature of the activity?   If Insurance Fraud, complete the INSURANCE FRAUD SECTION below.    
  POLICE CONTACT         
  Did the Tipster contact the police?     If yes, which Police Department? If No, assign a department 
   
      If other, please specify:      
       
    Date Notified (mm/dd/yyyy):      
  Did they work with a specific officer?  
  If yes, what was the name of the Officer? 
   
  Phone number:      
   
  Has anyone been arrested?     
  Complaint number, if known:      
  WHERE/WHEN CRIME OCCURRED         
  Date and time that the tipster observed the activity/crime(mm/dd/yyyy):   
      Time of activity:     
       
  City where the crime occurred:     
  Address/cross streets where the crime occurred:     
  The location:     
  SUSPECTS         
    Click here for  Click here for additional suspects    
Suspect 1                                Suspect 2    
  Last Name:     
  First Name:     
  Middle Name/Initials:     
  Alias/Street Name:     
  Address:     
  City:     
  Zip:     
  DOB/Age:     
  Sex:     
  Height:     
  Weight:     
  Eyes:     
  Hair:     
  Race:     
  Other Features:    Check all that applies.       
 
  What is the relationship with Suspect #1?     
  DESCRIPTION OF THE VEHICLE(S)         
   Click here for additional vehicles    
Vehicle 1                                Vehicle 2    
  Year:     
  Make:     
  Model:     
  Color:     
  Body Style:     
  Location of the vehicle:         
   
  H.E.A.T. PROGRAM         
  Have they previously reported a tip through HEAT?      
  How did they hear about the HEAT Program?    If other, please specify:      
             
  Tip taken by:           
  INSURANCE FRAUD SECTION         
  The suspect is:   BACK     


    
 
  Has the owner reported the vehicle stolen to his/her insurance company?  
  Name of the insurance company, if known:  
  Contact person at that company?  
  Their phone number?    
  Policy number, if known:    
  Circumstances of the fraud:
      
 
  GENERAL DESCRIPTION of ACTIVITY         
 Additional Information:          
         
  COMPLETE THE TIP         
  Your name:          
  Email:             
 
  HEAT (rev. 2010)