Poplar Bluff Police Department

 Incident Report Form

If you are from outside the Poplar Bluff area, and cannot come to the department personally, please use our attached “Statement Form“ to report your complaint or incident.  You will need to make phone contact with the department and advise our personnel that you will be mailing or faxing a written statement.  You should clearly print your First name, Middle initial, and Last name, along with your current Address, Telephone number, Date of birth, Social security number, and Employment information, in the assigned spaces at the header of the statement form.  In the Narrative section, please be as descriptive as you can regarding your compliant.  If you are filing a complaint against another individual(s), please include as much information about them as you can, and as much information regarding the incident that you can.  Please make sure and include the date and approx. time of the incident.  Disregard the “Casefile #C“ section at the top right of the page, as this is for departmental use only. You will then need to sign your name at the lower right hand corner of the form next to SIGNED:                 

Once your statement is received, you will most likely be contacted by a representative of this department, to confirm your statement form and it's information.

Please click the link in Red text below, which will open the Form in another page in Adobe format.  Simply print the Form from your computer to begin.  You may print as many forms as needed, and label them accordingly in the “Page No.” section.