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Narcotics Information Reporting Form

If you have information regarding drug activity occuring in Bellevue, Nebraska, please use this form to tell us about it.

Thank you for your cooperation in giving us this information. We appreciate your taking the time necessary to make your community a better place. 

The reason we created this form is to ensure that we can get as much information as possible. Try to answer as much as you're able to answer and please answer only what you're certain of.

Incomplete or inaccurate information will delay processing of the information and may prohibit us from quickly and effectively handling your complaint.

Tell us where the drug activity is occurring:

Inside business
Inside private residence
Alley or driveway
Hallway or corridor
Park or wooded area
Sidewalk or street corner
Vacant lot
From a vehicle
Garage
Other

Street address or business name:

Apartment number (if applicable):

Please check if the drug activity occurs:

Next to an elderly resident
Next to a handicapped resident
Near a school or church
Next to a playground or park

Security at this location: Please do not guess or assume the answers to the following questions. Answer only if you know. Please check if any of the following applies:

There are guns at this location
There are dogs inside this location
The doors are reinforced or gated
The windows are reinforced or gated

What type of drugs are being sold?

What day does most of the activity occur?

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Don't know

What time does the most activity occur?

12AM-2AM
2AM-4AM
4AM-6AM
6AM-8AM
8-AM-10AM
10AM-12PM
12PM-2PM
2PM-4PM
4PM-6PM
6PM-8PM
8PM-10PM
10PM-12AM
24 Hours A Day
Infrequently
Don't know

Drug dealer's name (if known):

Drug dealer's nickname or street name:

Dealer's age or age range:

Dealer's race

Dealer's sex

Dealer's phone number or pager number (123-456-7890):

Dealer's address:

Dealer's physical description:

Please tell us about any vehicles used by the dealers. Provide any information such as year, make, model, color, license plate, or other descriptive information

May we contact you?

Yes No

Please provide the following information if you want to be contacted:

Name

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Work phone

Home phone

E-mail

Officer Grubb with Chief Stacey

Officer Grubb with
Chief John Stacey