Potential Threat Affidavit Form
Submit a sworn statement regarding a potential threat. All information provided will be handled with discretion and used solely for investigative purposes.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of Incident
*
Describe the Potential Threat
*
Relationship to the Individual(s) Involved (if any)
Signature
*
Submit Affidavit
Submit Affidavit
Should be Empty: