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Report a Sexual Abuse

2. First Name
3. Last Name
5. Email
   Please provide your email address if you would like a response.
6. Your Phone
8. Victim's Information
10. First Name
11. Last Name
13. Booking Number
14. Jail Facility
    -- Select One --Blythe JailIndio JailLarry D. Smith CorrectionalRobert Presley Detention CenterSouthwest Detention CenterOther
16. Suspect's Information
18. First Name
19. Last Name
21. Please describe the suspect in as much detail as possible.
    Include such information as height, weight, build, age, race, color of eyes and hair, facial hair, tattoos, scars, unusual clothing, etc.
23. Please Provide the Incident Information
25. Where did the incident occur?
27. When did the incident take place?
29. Please give as many details as possible of the incident.
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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit Submit and Print

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