Adult Sexual Assault Notification (DRAFT)

CASE INFORMATION

Police Department

Police Department Case Number

Reporting Officer

Detective assigned

(If Applicable)

Date of sexual assault

Date sexual assault was reported

Location of sexual assault

Name

Date of Birth

Address

Gender

Race

Social Security Number

Name

Date of Birth

Address

Telephone Number

Gender

Race

Socal Security Number

Was victim interviewed?

Was suspect interviewed?

Was the defendant charged?

Complaint Number

(If Applicable)

Notes or other relevant information

Submitted By

Email Address

Was notification made to the BCPO via phone regarding this incident?

If YES - BCPO Detective name

(If Applicable)