Black & Missing, Inc.
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Report a Missing Person 

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.

* Indicates a required field (you must complete this information to submit the form).

Relative / Guardian Information

*First Name

Middle Name

*Last Name

*Street Address






Email Address

*Relationship to Missing Person

Missing Person Information

*First Name

Middle Name

*Last Name


Social Security Number


*Date of Birth

*Date Missing

*Age at Time

Missing From




*Location Person Last Seen
(include street address, cross streets, state)

*Circumstances of Disappearance

*Is there a custody order in place?

Yes     No

If YES, please answer the following:

Who is the custodial parent or guardian?

*Sex (check one)

Female     Male




*Race (check one)

American Indian Asian Black Hispanic White Biracial


Light Medium Dark

*Hair Length

Shaved Short Medium Shoulder Length Long

*Hair Color

Bald Black Blonde Brown Gray Lt. Brown Red Sandy White Other

*Eye Color

Black Blue Brown Green Gray Hazel Pink (albino)

*Wear Glasses / Contacts?

Yes No

Type (Glasses / Contacts):

*Identifying Marks / Characteristics
(e.g., scars, birthmarks, tattoos, piercings, walk/stride)


*Last seen wearing
(clothes, shoes, coats/jackets, hats: specify color/style):

Please upload the most recent picture of the missing person (include filesize limitations??):

Click on the "Browse" button below to select a file on your computer.

*Classification of Missing Person

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.

Investigating Law Enforcement Agency

*Name of Police Agency (Dept)

*Detective Name

*Police Case #



*Street Address





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