CHAMPAIGN POLICE DEPARTMENT
82 E. University Ave. Champaign IL, 61820; Phone (217) 351-4545
OFFICIAL POLICE REPORT
This report may be presented in person or mailed to the
Champaign Police Department, Attn: B.J.Meyers. Do not fax.
GEO-Code:
Badge:
Time Received:
Case Number:
Rpt Received By:
Date Received:
Identity Theft Information Provided Online
Type of Occurrence:
THEFT UNDER $500.00(0820)
CRIMINAL DAMAGE (1310)
500.00(0810)
LOST PROPERTY(9061)
OTHER
(9063)
Address of Occurrence:
Location type:
House (290)
Time Frame of Occurrence:
Start Date:
/
/
Time:
End Date:
Reporting Person/Victim:
Date of Birth:
/
Month Day
(176)
/
/
,
Last
/
,
First
Race:
Height
Year
Driver’s License Number:
State Issued:
Email address: __________________________________________
Permanent Address:
Street
Apt
Permanent Phone Number:
Time:
-
-
Sex: M
F
Weight
Soc Sec:
City
Middle
Hair
Eye_________
-
State
Cell Phone Number:
Zip
-
-
Local Address:
Street
Local Phone Number:
Apt
-
-
City
State
Zip
School:
Employer:
Address: ______________________________________
Phone Number:
-
-
Bicycle Information- IF applicable (480)
LEADS #
COLOR
MAKE
MODEL
SPEED
FRAME SIZE
WHEEL SIZE
STYLE
LOCKED
Y/N
SERIAL NUMBER
AGENCY/CITY REGISTERED
IDENTIFING MARKS
REGISTRATION NUMBER
VALUE $
Cell Phone Information- IF applicable (489) LEADS#
COLOR
MAKE
MODEL
TYPE
SERIAL NUMBER
PHONE NUMBER
CARRIER
CARRYING CASE
Y/N
VALUE $
BRAND
MATERIAL
OTHER IDENTIFIERS
Purse/Wallet Information- IF applicable (740)
COLOR
DESIGN/LOGO
FEATURES (bifold/zip top/etc)
VALUE $
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Missing Items/Contents- IF applicable
Drivers License (557) Y/N
State ID (647)
Y/N
Social Security (647)
Y/N
School ID(647)
Y/N
University Of IL ID(647) Y/N
Other Currency (550)
Y/N
State Issued
State Issued
Passport (647) Y/N
School Issued
Parkland ID (647) Y/N
Country
LEADS #
License Number
ID Number
Birth Certificate (647)
Y/N
US Currency (550) Y/N Value $
Value $
Checks/Credit/Debit Cards
Financial Institution Issued
Credit Card (541)
Cancelled
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Check (492) Numbers
Articles- IF applicable
Description
Item
Value
$
$
$
$
Vehicle Information- IF applicable
YEAR
MAKE
MODEL
PASSENGER CAR(821)
TRUCK(831)
PLATE
Damage to:
Hood
BOTH
Trunk
Window
REAR
Antenna
Owner if not same as above:
Date of Birth:
/
Month Day
OTHER
VIN
FRONT
Door
COLOR
VAN /SUV (833)
STATE
Missing Plate(s)(679)
LEADS #
Value $
Mirror
Hitch/Bumper
,
Last
/
Year
Social Security:
First
-
Apt
City
,
Middle
Sex: M / F
Race:
-
Address:
Street
State
Zip
*NOTE: It is the recommendation of the Champaign Police Department that you cancel all credit/debit cards along with checking accounts and
notify your financial institutions of your loss.
Please complete a short narrative with information on the situation surrounding the incident you are reporting.
Signature of reporting person/victim
________________________________Date____________________________
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Instructions for completing and filing your Police Report
Please make sure that when you are filling out your report you complete every blank that pertains to the
event you are reporting.
In order to file your report with our department, we are required to ask you for your personal
information, which includes:

Your Address and Phone number

Your Date of Birth

Your Race/Sex, Hair/Eye color

Your Employer’s name, address, & phone number

Name of School (If you are a student)

Your Vehicle, Bicycle, Cell Phone, Purse or Wallet information if applicable.
It is very important for you to include serial and model numbers of any items you report as lost or
stolen.
It is also important for you to include your estimated value of any items you are reporting lost,
stolen, or damaged.
If you have any questions about completing your report form you may contact the Champaign Police
Department at 217-351-4545 and speak to a Police Services Representative for assistance.
When your report is completed you may either mail the form back to the Police Department at:
82 E. University Avenue, Champaign, IL 61820 Attn: B.J. Meyers, or drop off the form at the
Front Desk of the police department which is open 24 hours a day, 7 days a week.
WE RECOMMEND THAT YOU DO NOT EMAIL YOUR COMPLETED REPORT BACK
TO THE POLICE DEPARTMENT. THE EMAIL ACCOUNT IS NOT ENCRYPTED.
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Police Department • 82 E. University • Champaign IL 61820 • (217) 351-4545 • fax (217) 403-6904 • www.ci.champaign.il.us
IDENTITY THEFT ACTION STEPS
If you think that you are a victim of fraud, call your credit card issuers to close or “flag” your
accounts, and call your bank to put an alert on your checking accounts.
If your social security number was used fraudulently, report the problem to the Social Security
Administration’s Fraud Hotline at 1-800-269-0271.
Contact the Federal Trade Commission at www.FTC.GOV to file a complaint, and receive
additional forms and affidavit assistance. (1-877-ID-Theft) You are also entitled to a free
yearly credit report, go to www.annualcreditreport.com The FTC will have the most up-todate information on the current contact information for the Credit Bureaus.
Credit Bureaus: Call the fraud units of each of the three major credit bureaus to report all
fraudulent transactions of which you are aware. Order a copy of your credit report from each,
and instruct each credit bureau to put a “Fraud Alert” and statement on your information asking
that creditors call you first before verifying any new credit applications. Do this by phone AND
IN WRITING.
TransUnion: www.tuc.com TransUnion, PO Box 6790, Fullerton, CA 92634: (800) 680-7289
Equifax: www.equifax.com Equifax Information Services LLC, PO Box 105069 Atlanta, GA
30348-5069 (800) 685-1111
Experian: www.experian.com Experian, PO Box 9530, Allen, TX 75013: (800) 379-3742
Have all three of the credit bureaus run a credit report , and have it mailed to you. Compare
the information on your report with what you know is legitimate.
Contact the Consumer Credit Counseling Service at 1-800-388-2227 for help in clearing false
claims from your credit report.
Creditors: Contact all creditors with whom your name has been used fraudulently, by phone,
and in writing, to inform them of the identity theft.
If your name, date of birth, and/or social security number has been used fraudulently, you will
need to file the appropriate reports with the police departments in the jurisdiction that the
crime occurred. If the identity theft involves the mail, you will also want to contact the local
U.S. Postal Inspectors office.
And in Illinois, you can also contact the Illinois Attorney General’s ID Theft hotline at 1-866999-5630 for further assistance.
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