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Forgery
Forged Check(s)
Reporting Person Information
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First Name
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Middle Name
Last Name
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Date of Birth
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Racial/Ethnic Identity
Asian
Black, African, or African American
Hawaiian or Pacific Islander
Hispanic, Latino/a/x, or Caribbean
Middle-Easterner or Arab
Multiracial or Mixed
Native American or Indigenous
White or Caucasian
Another
I decline to answer this question
Gender/Gender Identity
Male
Female
Another Gender Identity
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Phone Number
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Email Address
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Confirm Email Address
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Home Address
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Zip Code
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Driver's License Number
Driver's License State
If you are reporting on behalf of someone else, please click Add Additional below and include the victim's information.
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Incident Location Information
Please provide location information related to the incident.
Incident Location
(required)
Please provide date and time information for which the incident occurred.
Beginning Timeframe
(required)
Ending Timeframe
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Forgery - Forged Check
Please provide information related to the forged check(s) involved in this incident.
Issued By
Issued To
Amount
(required)
Check Number
Date Cashed
(required)
Location Cashed
(required)
Mobile Deposit
Yes
No
Please include an image of the check below in the Attachments Section. If you are unable to upload an image of the check, please describe the check and how it was altered in your narrative.
Suspect Information
Please provide any known suspect information related to this incident, if any.
Race/Ethnicity
Asian
Black
Hispanic or Latino
American Indian/Alaskan Native
Native Hawaiian/Other Pacific Island
Unknown
White
Age
Gender
Male
Female
Unknown
Hair Color
Eye Color
Height
Weight
Clothing
Vehicle Description
Vehicle License Plate
Name
Date of Birth
Phone Number
Address
Other Info
Hate/Bias Information
Please provide information related to the Hate/Bias Crime you feel in this incident, if any.
Do you feel this is a hate/bias crime?
(required)
Yes
No
If yes, please select why you feel targeted.
Disability
Ethnicity/National Origin
Gender/Gender Identity
Racial
Religious
Sexual
Unhoused
If yes, please explain in your narrative of events on why you feel this is a hate/bias crime.
Incident Narrative
Describe your incident here, and please be as detailed as possible.
Incident Narrative
(required)
Documents, Pictures or Videos
Please provide any Documents, Pictures or Videos to Support your Case
Contact Information
Please provide the best e-mail and phone number to reach you.
E-Mail Address
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Mobile Phone Number
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Filing a false police report is a crime (ORS 162.375). Please review your information above.
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400 E Main St
Cottage Grove, OR 97424
Phone: (541) 942-9145
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