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2. Important Notice
   Arkansas Code 5-54-122: Filing false report with a law enforcement agency. Report means any communication, either written or oral, sworn or unsworn.
4. Offense
   -- Select One --Domestic BatteryDomestic AssaultViolation of Domestic Protection OrderStalking

   Please Choose an offense. For details see Offense Descriptions.
5. Offense Descriptions
   View offense documents.

   The information listed here is unofficial and only intended to assist citizens in understanding Domestic Violence Laws and Definitions
7. Date / Time of Offense
   Date / Time of Offense

   Date / Time of Offense
8. Address / Location of Offense
12. Your Name
13. Your Date of Birth
15. Your E-Mail Address
16. Your Phone Number
18. Your Address
20. City
21. State
22. Zip
24. Business Name (If Involved)
25. Phone Number
27. Street Address
29. City
30. State
31. Zip
35. Suspect / Witness / Offender
    -- Select One --OffenderSuspectWitnessWitness / Suspect
37. Name
38. Date of Birth
39. Phone Number
41. Street Address
43. City
44. State
45. Zip
47. Suspect / Witness / Offender
    -- Select One --OffenderSuspectWitnessWitness / Suspect
49. Name
50. Date of Birth
51. Phone Number
55. Property
    -- Select One --DamagedStolen
56. Property Description
57. Serial Number
58. Value
60. Property
    -- Select One --DamagedStolen
61. Property Description
62. Serial Number
63. Value
65. Narrative
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67. 1. Receive an email copy of this form.
68. Email address

    This field is not part of the form submission.

69. Submit

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