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Incident Details

N/ARobberyBurglaryCounterfeitBad ChecksUSPSFedEx/UPSTheftEbayFraud

Date of Offense

Hour: Min:AMPM

Date Offense Reported

Hour: Min: AMPM

Offense Details / Intelligence Information:

About the victim

N/ACollectorDealerInvestorIndividual

Location

N/AResidenceBusinessAt Numismatic EventTraveling to Numismatic EventTraveling from Numismatic Event

Loss:

Other - Please fill out box below.CollectionBusiness InventoryInvestmentU.S. CoinsU.S. CurrencyForeign CoinsForeign CurrencyBullionTokens/MedalsAncient

Other Loss:

Amount of Property Loss: (U.S.Dollars)

Inventory / Property Type:

N/AWholesaleRetail

Insured:

N/AYesNo

Description of Property Stolen: (Key Items)

Victim's Contact Information

Business Contact Information

Suspect Information

Vehicle Year

Vehicle Make

Vehicle Model

Vehicle Model

Investigating Agency:

Investigator Assigned:

Investigator's Phone Number:

Agency Report Number: