Form Center

Retail Theft

2. If you need immediate assistance, please call the main number at 860-886-5561 Ext. 6. If this is an emergency, please call 911. If you wish to report activity that is on-going and does not require immediate attention, please complete the form below.
   (Warning: Internet IP addresses are captured when submitting this form. Intentionally completing a form with false information can result in a criminal investigation)

   (Warning: Internet IP addresses are captured when submitting this form. Intentionally completing a form with false information can result in a criminal investigation)

6. Please complete the form below for retail theft only:

8. Business Name*

10. Address*

12. City

13. State

14. Zip

16. Phone Number*

17. Email

18. Preferred method of communication*

    1. Email
    2. Telephone

20. Name of Reporting Party*

21. Title of reporting Party*

23. Date of Birth*
    Date of Birth

24. Sex*
    -- Select One --FemaleMale

25. Race*
    -- Select One --AsianBlack or African AmericanAmerican Indian or Alaska NativeNative Hawaiian or other Pacific IslandUnknownWhite

26. Ethnicity*
    -- Select One --Hispanic OriginNot of Hispanic Origin Unknown

30. Date and Time of Theft*
    Date and Time of Theft

    Date and Time of Theft

31. Total Value of Theft*

33. Description of Stolen Items with Individual Values*

    Be as descriptive as possible, i.e. make, model, color, serial number, value

35. Suspect Information and Description (Name if known)*

37. Pictures, Video or Supporting Documents

39. Additional details (optional)

43. By completing this form, I certify that the information contained herin is true, correct, and complete to the best of my knowledge and belief. I further acknowledge that any intentional false statement or misstatement may be a violation of 53a-180c.
    Please type your name below for the purpose of electronically signing this report (CT Sec. 1-272. Legal recognition of electronic records, electronic signatures and electronic contracts).

    Please type your name below for the purpose of electronically signing this report (CT Sec. 1-272. Legal recognition of electronic records, electronic signatures and electronic contracts).

45. First and Last name*

46. Date Signed*
    Date Signed

Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field