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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.

Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit Submit and Print

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