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Your Address*


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Have you contacted us before concerning this?
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Please list any witnesses or other persons involved. 
Be sure to include contact information including home
addresses and telephone numbers.


Please list any employees or officers involved in
the incident.  Names, ID numbers, car numbers etc.

Please give a brief synopsis of the incident including
the date and time, location and description.  A more
detailed account of the incident will be taken during
your initial interview with an investigator.


Were you arrested?
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Were you taken into custody?
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Please list any TRAFFIC charges originating from this incident:


Please list any CRIMINAL charges originating from this incident:


Please be advised that submitting a false or malicious complaint can subject you to litigation and that it is a crime to make a false police report.  Anyone found to have submitted a false police report will be prosecuted under the authority of Virginia State Code, Section 18.2-461, which shall be punishable as a Class 1 misdemeanor.  Maximum possible penalty is one year in jail and/or $2500 fine.

By pressing the "SUBMIT" button below, you are indicating that the events and actions you have depicted are true and accurate to the best of your knowledge and belief.