Walnut Creek Police Department - Vandalism Report

Incident Location:

Where did this take place?
(a physical address)

Last Name:
First Name:
Sex:
Race:
Date of Birth (MM/DD/YY):
California Drivers License No:
Address:
Apt/ Room/Suite:
City, State, Zip:
Home Telephone Number:
Work Telephone Number:
Other Telephone Number:
Reply E-mail:

The last time I saw the property undamaged was:

Date (MM/DD/YY):
Time (24 hour format, i.e. '2315'):

I first discovered the damage on:

Date (MM/DD/YY):
Time (24 hour format, i.e. '2315'):

Item vandalized was a:
Make:
Model:
Serial Number:
Other distinctive features:
Dollar amount of the damage done to this item:
Type and nature of damage done:
Was this a case involving graffiti (tagging)?:

Note: if more than one item, please describe briefly in comments, below

Comments or additional Information (optional; 255 characters maximum)

	I certify under penalty of perjury that the information I am submitting is, to the best of my knowledge, complete, truthful and accurate. (An officer may call you back if we need more information.) False police reports are a violation of Penal Code Section 148.9.
	I do not know who is responsible for this (if you do, you must call us to report it).
	To my knowledge, there are no witnesses to this damage.

Now, go back and double-check all your information and hit Submit when you are done.

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