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CRIME STATISTIC REPORT FORM

All fields are required
Reporting Person:
Classification (see definitions below):
Telephone #
( ) -
Time of Incident:
Location of Incident:
Date of Incident
/ / (mm/dd/yyyy)
Brief Description of Incident

Check the appropriate answer to the following questions:
Did the crime occur in a building (B) or on the street (S)?

B
S
Don't Know

Did the crime occur on IUSB owned, controlled, or leased property?

Yes
No
Don't Know

Did the crime occur at a University-sponsored activity or event?

Yes
No
Don't Know

Was the crime reported to the IU Police Department?

Yes
No
Don't Know