Law Enforcement/SIU Intake Form

	LAW ENFORCEMENT or SIU HEAT TIP REPORT
	11/18/2008


Use TAB to move throughout the form. If you hit "ENTER", you will submit an incomplete form. If this happens, please email HEAT to let them know. Then start again.

	Today's Date:

ABOUT THE TIPSTER
	Name
		Anonymous? Code Name?
	Address
	Apt.
	City
	Zip
	County
	Phone numbers, beginning with area code.	Home Phone
		Work Phone
		Cell Phone
		Pager
		Other
		If Other, please specify (parent's home, friend, etc.)
	Okay to contact?
	Which number?
	Who to ask for?
	Okay to leave message?	Yes No
	If yes, which number?

NATURE OF ACTIVITY
	Nature of the activity?	If Insurance Fraud, complete the INSURANCE FRAUD SECTION below.

POLICE CONTACT
	Did the tipster contact the police?	Yes No
	Police Agency:
	If Other, please specify.
	Date Notified
	Did they work with a specific officer?	Yes No
	Name of officer
	Phone number
	Has anyone been arrested?	Yes No Don't Know
	Complaint number, if known:

WHERE/WHEN CRIME OCCURRED
	Date and time that the tipster observed the activity/crime	Date Approximate Time
	City where crime occur
	Address/cross streets where the crime occurred
	The location is a	residence business

SUSPECTS		Click here for Additional Vehicles
	Suspect #1	Suspect #2
Last Name
First Name
Middle Name/Initial
Alias/Street Name
Address
City
Zip
DOB/Age
Sex
Height
Weight
Eyes
Hair
Race

Other Features: Check all that apply.
	Suspect #1	Suspect #2
	Tall Short Lt Complexion Medium Complexion Dark Complexion Black Complexion Heavy Build Slender Build Average Build Long Hair Short Hair Curly Hair Tattoos Glasses Youth/Teenager Several Youths	Tall Short Light Complexion Medium Complexion Dark Complexion Black Complexion Heavy Build Slender Build Average Build Long Hair Short Hair Curly Hair Tattoos Glasses Youth/Teenager

What is the relationship with Suspect #1?

DESCRIPTION OF VEHICLE(S)		Click here for Additional Vehicles

	Vehicle #1	Vehicle #2
Year
Make
Model
Color
Body Style

Location of the vehicle

H.E.A.T PROGRAM
Have they previously reported a tip through HEAT?		Yes No
How did they hear about the HEAT Program?		If Other, please specify:
The tip was taken by

INSURANCE FRAUD SECTION

The suspect is:	the owner of the vehicle?	the person hiding the vehicle?
	the person disposing of the vehicle?	other (describe below)
Describe:
Has the owner reported the vehicle stolen to his/her insurance company?		Yes No Don't Know
	Name of insurance company
	Contact person at that company
	Their phone number?
	Policy number, if known.
Circumstances of the fraud

COMPLETE THE TIP
Your Name:		A temporary tip number will be assigned to this tip.
E-mail:		Please contact 1 (800) 242-HEAT within 48 hours to receive the permanent tip number.

HEAT (Rev. 2004)

ADDITIONAL SUSPECTS

	Suspect #3	Suspect #4
Last Name
First Name
Middle Name/Initial
Alias/Street Name
Address
City
Zip
DOB/Age
Sex
Height
Weight
Eyes
Hair
Race

Other Features: Check all that apply.
	Suspect #3	Suspect #4
	Tall Short Lt Complexion Medium Complexion Dark Complexion Black Complexion Heavy Build Slender Build Average Build Long Hair Short Hair Curly Hair Tattoos Glasses Youth/Teenager	Tall Short Light Complexion Medium Complexion Dark Complexion Black Complexion Heavy Build Slender Build Average Build Long Hair Short Hair Curly Hair Tattoos Glasses Youth/Teenager

What is the relationship with the other suspects?
Back to SUSPECTS

ADDITIONAL VEHICLES

	Vehicle #3	Vehicle #4
Year
Make
Model
Color
Body Style

Do you know the location of the vehicle?