Submitting Report...
Confirm Submission WITHOUT Appointment
You have not selected an appointment date/time. Are you sure you wish to continue?
Please Wait, Uploading File....
Identity Theft
Unauthorized use of Debit/Credit Cards or Accounts, Personal/Business information used to fraudulently create accounts, Etc.
Reporting Person Information
Please enter your information.
First Name
(required)
Middle Name
Last Name
(required)
Date of Birth
(required)
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
I decline to answer this question
Phone Number
(required)
Email Address
(required)
Confirm Email Address
(required)
Home Address
(required)
Zip Code
(required)
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.
+ Add Additional : Reporting Person Information
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
(required)
Identity Theft
Unauthorized use of Debit/Credit Card, Accounts opened in your name, Taxes Files, Etc.
Identity Type
(required)
Debit/Credit Card(s)
Accounts opened in your name (Verizon, etc.)
IRS Taxes
Other
Description if Type is Other
You MUST provide information related to the specific type of Identity Theft.
Name on Card
Card Number (at least last 4 digits)
Issuing Bank
Location Used
Date Used
Time Used
Exact Amount of Transaction
+ Add Additional : Identity Theft
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
(required)
Mobile Phone Number
(required)
We are currently not yet accepting appointments, please select No Appointment
(required)
No Appointment
Schedule Contact Appointment
Please pick an available date and time for an officer to contact you via Phone or Zoom.
Filing a false police report is a crime (ORS 162.375). Please review your information above.
Submit Report
400 E Main St
Cottage Grove, OR 97424
Phone: (541) 942-9145
(c) Copyright 2023 - Cottage Grove Police Dept. - All Rights Reserved.
