Below is a form requesting a physical description of the missing person, as well as current information about you
and the investigating law enforcement agency.
In the event a public notification is prepared for the missing
person, please complete this form with detailed descriptive information, as it should appear on the public
notification.
Please complete the form in its entirety.
Relative / Guardian Information |
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*First Name |
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Middle Name |
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*Last Name |
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*Street Address |
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*City |
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*State |
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*Zip |
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*Phone |
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Fax |
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Email Address |
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*Relationship to Missing Person |
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Missing Person Information |
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*First Name |
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Middle Name |
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*Last Name |
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Nickname |
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Social Security # |
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NCIC # |
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*Date of Birth |
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*Date Missing |
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Missing From |
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*County |
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*City |
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*State |
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*Location Person Last Seen
(include street address, cross streets, state) |
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*Circumstances of Disappearance |
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*Is there a custody order in place? |
Yes
No |
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If YES, please answer the following: |
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Who is the custodial parent or guardian? |
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*Gender (check one) |
Female
Male |
*Height |
Feet:
Inches: |
*Weight |
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*Race (check one) |
American Indian
Asian
Black
Hispanic
White
Biracial
Other |
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*Complexion |
Light
Medium
Dark |
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*Hair Length |
Shaved
Short
Medium
Shoulder Length
Long |
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*Hair Color |
Bald
Black
Blonde
Brown
Gray
Lt. Brown
Red
Sandy
White
Other |
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*Eye Color |
Black
Blue
Brown
Green
Gray
Hazel
Pink (albino) |
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*Wear Glasses / Contacts? |
Yes
No |
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Type (Glasses / Contacts): |
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*Identifying Marks / Characteristics (e.g., scars, birthmarks, tattoos, piercings, walk/stride) max 255 characters |
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Jewelry |
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*Last seen wearing (clothes, shoes, coats/jackets, hats: specify color/style): |
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Please upload the most recent picture of the missing person. Click on the "Browse" button below to select a file on your computer. |
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*Classification of Missing Person |
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Disability: Person missing is under proven physical/mental disability or is senile thereby subjecting herself/himself or others to personal or immediate danger.
Endangered: Person missing under circumstances indicating his/her physical safety is in danger.
Involuntary: Person missing under circumstances indicating the disappearance was not voluntary.
Catastrophe Victim: Person who missing after a catastrophe.
Cold Case: Homicide of a missing person that remains unsolved and "on the books".
Other: A person 21 or older, not meeting the criteria for entry in any other category, who is missing and for whom there is a reasonable concern for his/her safety. |
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Investigating Law Enforcement Agency |
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*Name of Police Agency (Dept) |
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*Detective Name |
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*Police Case # |
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*Phone |
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Fax |
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*Street Address |
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*City |
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*State |
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*Zip |
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