Missing Person Intake Form Disclaimer:This form is not intended to replace the need to write a general or supplemental police report.Report Number Date Reported Missing MM slash DD slash YYYY Type of MissingMissing ChildRunaway ChildMissing AdultHigh Risk Missing PersonInformation on Missing PersonName Aliases SSN SexFemaleMaleUnknownRaceAm In/AlaskanAsianBlackMulti-RacialUnknownWhiteDate of Birth Month Day Year Place of Birth Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Photo ProvidedYesNoCell #Cell Phone Subscriber Info Social Media Accounts Age Height Weight EyesBlackBlueBrownGrayGreenHazelMaroonMulticolorPinkUnknownHairAuburnBaldBlackBlondeBrownGrayOtherRedWhiteSkin ToneAcne or RuddyAlbinoDarkFairLightLight BrownMediumMedium BrownOliveYellowHair TextureWavyCurlyStraightTeasedHair Style Hair Length Hand PreferenceRight HandedLeft HandedBuildLargeMediumMuscularObeseThinLast Seen Wearing Handicaps, Illness or Mental Illness Additional informationsuch as physical features / characteristics / scars / marks / tattoos / piercing / medical information / jewelry Describe any physical anomalies / prosthetics / surgical or cosmetic implants, etc. Occupation/School Work/School Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Length of time missing and why reporting person suspects the person is missing and not voluntary Is foul play suspected?NoYesIf foul play is suspected explain Previous incidents of running away?NoYesIf previous incidents of running away explain History of substance abuse?NoYesIf previous history of substance abuse explain Previous threats of suicide?NoYesIf previous threats of suicide explain Last know location Possible destination Frequent locations Last person w/contact, physical description, vehicle information License Plate and Vehicle InformationDriver’s license number Driver’s license expiration date License plate type Vehicle VIN # Vehicle Year Vehicle Make Vehicle Model Information on Person Making the ReportName Relationship TX Full Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code SignatureDate MM slash DD slash YYYY Time Hours : Minutes In-taking Employee/Supervisor ApprovalIn-taking employee’s name Date MM slash DD slash YYYY Approving supervisor Date MM slash DD slash YYYY To be Completed by the TelecommunicatorTC’s Name NCIC Number LEADS Number Silver AlertInclude the 2 attached Silver Alert PDF’s Drop files here or Select files Max. file size: 80 MB. Amber AlertInclude the 2 attached Amber Alert PDF’s Drop files here or Select files Max. file size: 80 MB. Enter email address to send this completed for to If entering multiple emails, separate them using a comma. Ex: john@cityofelgin.org, jane@cityofelgin.org