Sheriff Logo SUMMIT COUNTY SHERIFF'S OFFICE
Post Office Box 210 / 510 North Park Avenue
Breckenridge, Colorado 80424
970.453.2232 | Metro 303.573.7598 | FAX 970.453.7329

COLD OFFENSE REPORT FORM

CASE REPORT #
(For Official Use Only)
WHAT OCCURED:
Lost/Missing Property Theft (Stolen Property)
 
WHEN OCCURED: * indicates a required field
Enter the Date or Approximate Date of the Occurrence  
*Date mm/dd/yy *Time hh:mm
a.m. p.m.
WHERE OCCURED:
Business Name
(if any)		      
House Number Street Name  
Building Apt/Suite  
City State Zip

Type of Victim:

Type of Location *
07 Convenience Store 13 Highway/Road/Alley 19 Rental/Storage Facility
08 Department/Discount Store 14 Hotel/Motel/Etc. 20 Residence/Home
09 Drug Store/Dr. Office/Hospital 15 Jail/Prison 21 Restaurant
10 Field/Woods 16 Lake/Waterway 22 School/College
05 Commercial/Office Building 11 Government/Public Building 17 Liquor Store 23 Service/Gas Station
06 Construction Site 12 Grocery/Supermarket 18 Parking Lot/Garage 24 Specialty Store
      25 Other/Unknown
WHO ARE YOU:
Last Name* First Name* Middle
Date of Birth
* mm/dd/yy 		Age Your Gender
Occupation Email    
Driver's License State    
Race
Residence:
Street Number Street Name  
Building Apt. Number
City State Zip
Home Telephone
*xxx-xxx-xxxx

Cell Phone
Mailing Address
(if different than physical address) 		PO Box
City State Zip
Businesses:
Business Name Street Number Street Name
PO Box Building Suite
City State Zip
Work Telephone
*(xxx)xxx-xxxx
Ext
CASE REPORT #(For Official Use Only)


WHAT WAS LOST OR STOLEN
ITEM 1:
Color Quantity Description
Make Model Serial#
(Choose One) Lost Stolen Value Each Total Value
ITEM 2:
Color Quantity Description
Make Model Serial#
(Choose One) Lost Stolen Value Each Total Value
ITEM 3:
Color Quantity Description
Make Model Serial#
(Choose One) Lost Stolen Value Each Total Value
VICTIM'S NAME * DATE*  
PHONE NUMBER*
(xxx)xxx-xxxx		 TIME* hh:mm a.m. p.m.
By submitting information on the report to the Summit County Sheriff’s Office, you are making the following representation: Under penalty of perjury, I declare that this report and the information contained herein is true, correct, and complete to the best of my knowledge and belief. Reporting of any crime that is false is punishable by law and may result in criminal prosecution.