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Police Follow-up Form

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THE INFORMATION YOU REQUEST (Check Applicable):
I wish to file a(an):*
1. Update on Case
2. Suggestion
1. Inquiry
2. Other
You are: *
1. Victim
2. Complainant (Employee of Victim)
1. Other:
Contact Information
Full Name*
Date of Birth*
Your Driver’s License/State Id (If available):
Email Address
Street Address:*
Phone Number*
Work Phone:
INCIDENT DETAILS:
Brief Description of Incidident or Request:*
Location of Incident:*
Date of Incident:*
Time of Incident:
Name of Bensenville Officer/Employee(If known):
Name of Witness(es) or Others Involved (If known):
Witness Address (If known):
Witness Phone:
Statement/Description of Incident/Reason for Request/Additional Info. about Case:*