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2. Please read the following paragraphs:

   The information I’ve provided on this form is correct to the best of my knowledge. I understand that providing false information could make me subject to fine, imprisonment, or both under State of Illinois Law.

   Complaints filed via this website are processed and may be referred to other law enforcement/regulatory agencies for possible investigation. Any investigation opened on complaints filed on this web site is opened at the discretion of the Peoria Police Department.

4. Advisory:

   You are about to file a complaint with the Peoria Police Department. The confidentiality of the information you provide may be affected depending on state law. As such, we cannot guarantee that your complaint will remain confidential. Submitting the form indicates that you understand this.

6. Please tell us about the location.

   As many details as you may provide will be helpful. If the activity occurs inside a business or nightclub, please tell us the name of the property.

8. Property Name
9. Street Number
11. Street Direction
    -- Select One --NorthNortheastEastSoutheastSouthSouthwestWestNorthwest
12. Street Name
14. Apartment Name/Number
15. Peoria, IL Zip Code
    -- Select One --6160161602616036160461605616066161461615
17. Street Name/Corner
18. Violation Proximity:

    1. Near a school
    2. Next door to elderly resident
    3. Next to a place of worship
    4. Near a playground or recreation center
    5. Street corner
    6. Inside a business
    7. Inside a private residence
    8. Alley or driveway
    9. Hallway or corridor
    10. Park or wooded area
    11. Vacant Lot
    12. Garage
    13. Other
    14. Motor Vehicle (complete Drug Dealer Vehicle Information section)

    Please check the appropriate box if the violation location meets any of these conditions.

20. Please describe
22. Drug Dealer Vehicle Information:

    Use this area to tell us about any vehicles used by the drug dealer and to deliver drugs to this location.

24. Vehicle make
    -- Select One --CadillacChevroletDodgeFordHondaMitsubishiToyotaVolkswagenOther
25. Vehicle Model:

    (For Example: Eldorado, Camaro, Cutlass)

27. Vehicle Color
28. Year
30. License Plate Number
31. License Plate State
33. Other/More Details
35. Please tell us about the security at this location:

    1. I have seen guns at this location.
    2. There are dogs inside this location.
    3. The doors are reinforced or gated.
    4. There are cameras or alarms at this location.
    5. There are windows reinforced or gated.

    Help us determine what we're up against so we can take the necessary precautions. If you don't know the answer, leave it blank. Do not guess or assume.

37. Further information

    If you checked any boxes on the last question, please provide more details and information.

39. Please tell us about the activity:

    Complete the following areas to acquaint us with the type of drug activity you are reporting and when it occurs.

41. Drugs being sold
    -- Select One --Crack cocaineCocaine - powderHeroinIce/MethamphetamineLSDMarijuanaPCP/Angel DustOther/Multiple
42. Please identify

44. Do not exaggerate. We will be using this information to verify the report.

46. Days when the activity is most pronounced

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
    7. Sunday
    8. All week
    9. Don't know

    Select all that apply.

47. Times when the activity is most pronounced

    1. Midnight to 2 am
    2. 2 am to 4 am
    3. 4 am to 6 am
    4. 6 am to 8 am
    5. 8 am to 10 am
    6. 10 am to noon
    7. Noon to 2 pm
    8. 2 pm to 4 pm
    9. 4 pm to 6 pm
    10. 6 pm to 8 pm
    11. 8 pm to 10 pm
    12. 10 pm to midnight
    13. Infrequently
    14. 24 hours a day
    15. Not sure

    Select all that apply.

49. Describe the activity:

    Use this space to tell us about the activity. Explain as much as possible about the dealing you are reporting. This is the area where you tell us everything you know. You can't tell us too much!

51. Please tell us about the drug dealer or distributor:

    If you know the drug dealer's name, description, current address or phone number, please provide it.

53. Dealer's Name
54. Dealer's Nickname
56. Dealer's approximate age/age range
57. Dealer's race and sex
    -- Select One --Asian maleBlack maleHispanic maleWhite maleOther maleUnknown maleAsian femaleBlack femaleHispanic femaleWhite femaleOther femaleUnknown female
59. Dealer's phone number
60. Dealer's pager
62. Dealer's address

    Street, Apartment, City, State, ZIP

64. Dealer Description

    Please describe the violator's appearance. Include scars, tattoos, clothes, jewelry descriptions, hair styles and any other distinguishing marks. If you can't provide a description, enter "Unknown" in this space.

66. Important Disclaimer:

    Communications made through this electronic mail and message system shall in no way be deemed to constitute legal notice to the City of Peoria, IL, the Peoria Police Department or any of its agencies, officers, employees, agents, or representatives, with respect to any existing or potential claim or cause of action against the City or any of its agencies, officers, employees, agents, or representatives, where notice to the city is required by any federal, state or local laws, rules or regulations.

Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit

* indicates a required field