Name (OPTIONAL - LEAVE BLANK TO REMAIN ANONYMOUS):

Phone (OPTIONAL - LEAVE BLANK TO REMAIN ANONYMOUS):

Email (OPTIONAL - LEAVE BLANK TO REMAIN ANONYMOUS):

Do you request a follow up call from an investigator (Not applicable if you wish to remain anonymous)?

Follow-up Requested

County of primary drug activity:

Select County... LaGrange Noble DeKalb Steuben Allen Whitley Kosciusko

Names of those involved (if known):

Places where those involved are employed including shift:

Type of drugs (if known):

Days of the most activity: (eg.M,T,W,TH,F,SA,SU):

Time frame of most activity (eg.8p-2a):

Vehicles involved: (Please include colors, makes, models and license plate number if known):

General Narrative: (please describe any details that you are aware):