Name:
Email Address:
May we publish your 
name in our online report:
Yes
May we publish your email 
address in our online report:
Yes
Date of Offense:
MM/DD/YY
Suspect's Name:
Suspect's Email Address:
Suspect's ISP#:
Nature of offense:
Request for Date Solicitation for Sex
Other: 
Where did the offense occur:
Via Email Message Board Chat room
Name of Message Board
or Chat Room:
URL of Message Board
or Chat Room:
Please copy and paste the
full message headers:
Please copy and paste the 
full text of the message:
Have you experienced problems
with this person before:
Yes
Additional Information:

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