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2. Address of Complaint*

   Please give the address and description of residence that you are reporting

4. Types of Substances inside the residence*

   Please list the types of narcotics being used/sold at this residence

6. Are drugs being used, sold, or both at this residence*
8. Who all are at this residence*

   Please list the names of people at this residence using/selling narcotics

10. May we contact you about this?

    Please list your Name, Phone Number, and/or email address

12. Please describe what you are seeing, noticing at this residence to include types of activity and vehicles*
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14. 1. Receive an email copy of this form.
15. Email address

    This field is not part of the form submission.

16. Submit

* indicates a required field