Police report
Statement about a crime or offence
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Generated document
To the Head of [Police department name]
from [Full name]
Address: [Address]
Phone: [Phone]
STATEMENT
about an offence / crime
On [Date] at [time] at the address: [Place of incident], an offence was committed.
Circumstances:
[Detailed description: what happened, who was present, what evidence exists]
I request:
1. Register this statement.
2. Conduct a verification / investigation of the facts stated.
3. Bring the responsible persons to justice.
Please inform me about the decision taken in accordance with the procedure and time limits established by law.
I have been warned about criminal liability for knowingly false reporting of a crime.
4/12/2026 _________________ / [Full name] /
(signature)Important
- • You can submit the statement to any police department
- • Obtain a receipt / registration confirmation
- • Keep a copy of your statement