3. If you wish to report Anonymously please submit through
   Midland Crimestoppers at www.midlandcrimestoppers.com
   or Dial 432-694-TIPS (8477).
   
   If this is an Emergency Call "911"
5. Description: (Include Who, What, When, Where and How Do You Know)*
7. Location of Incident*
9. Date/Time of Incident*
   Date/Time of Incident

   Date/Time of Incident
11. Full Name*
13. Address*
15. Phone Number*
17. Email Address*
Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

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