Secret Witness of Shasta County, Inc.

Secret Witness of Shasta County, Inc.

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Tip Information

Type of Crime?

(i.e. robbery, assault, etc.)


(i.e. address, street, buss.)

When did the crime occur (Date & Time)?

Do you know who committed the crime?

Yes   No

Name of Suspect?

(if known)

Description of Suspect:



Sex:  Race:

D.O.B. or Age:

Height:  Weight:   Eyes:  Hair:

Any further description, such as: Tattoos, Scars, Glasses, Hair Style, Clothing, Employer, Etc.

Address of suspect?
(Include Apt. & Space No.'s) 


(if known)

City     State

Suspect Telephone Numbers:

#1--  #2 --

Vehicle Description if you have one:


Year: Make:  Model:  Color:

Body Style:  License #:  State:

Any further vehicle description, such as: Camper, Soft-top, damage, Etc.

Any other information you would like to leave? 


How did you hear about Secret Witness? 

Please create a unique ten digit number, starting with the current date, plus four numbers; Ex.0401080177 for April 1, 2008 with 0177 being the unique last four numbers.  This will be used as your TIP number for collecting on the reward.

(Write this code down and save it for reference/reward)

Reporting Party Information:

Address: City:  State:

Telephone #1--
Telephone #2--

Would prefer to remain Anonymous:>


To verify this form please enter the number in red Here>





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