Site Map
Print This Page
Drug Information Reporting Form
If you have information regarding drug activity occurring in Salina please use this form to tell us about it.
Thank you for your cooperation in giving us this information. We appreciate your concern and effort to make your community a better place.The reason we created this form is to ensure that we can get as much infomation as possible. Try to answer as much as you're able to answer and please answer only what you're certain of.
All information you provide will be held in strict confidence.
Tell us where the drug activity is occurring Inside Business: Inside Private Residence: Alley or Driveway: Hallway or Corridor: Park or Wooded Area: Sidewalk or Street Corner: Vacant Lot: From a Vehicle: Garage: Other: If Other (please explain): Street Address or Business Name: Apartment Number (if applicable): Security at this location Please do not guess or assume the answers to the following questions. Answer only if you know. Please check if any of the following applies There are Guns at This Location: There are Dogs Inside this Location: The Doors are Reinforced or Gated: The Windows are Reinforced or Gated: The Premises are Video Monitored: What Types of Drugs are Being Sold? Cocaine: Marijuana: Methamphetamine: Other: If Other (please specify): What Day Does Most of The Activity Occor? Monday: Tuesday: Wednesday: Thursday: Friday: Saturday: Sunday: What Time Does The Most Activity Occur? 12:00am - 2:00am: 2:00am - 4:00am: 4:00am - 6:00am: 6:00am - 8:00am: 8:00am - 10:00am: 10:00am - 12:00pm: 12:00pm - 2:00pm: 2:00pm - 4:00pm: 4:00pm - 6:00pm: 6:00pm - 8:00pm: 8:00pm - 10:00pm: 10:00pm - 12:00am: 24 Hour a Day: Infrequently: Don't Know: Drug Dealer's Information Drug Dealer's Name (if known): Drug Dealer's Nickname or Street Name: Drug Dealer's Age or Age Range: Drug Dealer's Race: Please Select One White Black Hispanic Asian Indian Other Drug Dealer's Sex: Please Select One Male Female Drug Dealer's Phone Number or Pager Number: (please format as 123-456-7890) Drug Dealer's Address: Drug Dealer's Physical Description: Please tell us about any vehicles used by the dealers. Provide any information such as year, make, model, color, license plate, or other descriptive information Please include any additional information that would be helpful in this investigation. Such as, who else is living at the residence that is actively involved in dealing narcotics; who else is living in the residence; who are the people purchasing the drugs and any other people we may contact. Your Personal Information May We Contact You?: Yes No Please Provise The Following Information if you Want to be Contacted: Name: Street Address: Address (cont.): City: State/Province: Please Select AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip/Postal Code: Work Phone Number: Home Phone Number: Email Address: DISCLAIMER: Our site allows you to provide information about drug use or production anonymously. The Drug Task Force and its member agencies will determine, in its sole discretion, whether or not it will investigate any such reports. Information provided anonymously may be shared among the member agencies of the Task Force or with other public agencies. Any information you provide will be used only to respond to you or to investigate a possible crime.
City/County Building 300 W. Ash Street Salina, KS 67401
Copyright © 2006 City of Salina, Kansas. All Rights Reserved | Disclaimer | Powered By QScend Technologies, Inc.