Your e-mail address:                                    Your full Name:

Your Address (include city & state):             Your Date of Birth:

Your Social Security Number:                       Your Home Phone Number:

Driver's License number and state:

THE REPORT SHOULD INCLUDE:

Location of Incident:

Cell Phone make and model

Cell Phone number

Cell Phone provider

Last Time seen

Have you notified your provider?

Value of item

--------------------------------Example Writing------------------------------------

  E-mail: jhappy@yahoo.com

  Name: John Richard, Smith

  Address: 123 Main St Waltham MA

  Date of Birth: 01/01/1956

  Social Security Number: 000-00-0001

  Home Phone Number: (123) 456-6789

  Driver's License: MA-S1234567

My cell phone is missing and I believe I have lost it. I last saw my Nextel s800i on 08/31/2008 when I placed it in my gym bag at the YMCA 725 Lexington St.  Today 09/05/2008 I noticed my cell phone was not in my gym bag. I contacted my provider Sprint and they indicated there was no activity on my cell phone and they indicated I needed a police report. My cell number is (987) 654-3210 I have tried to call but get only voicemail, the phone is valued at $100. I have no idea where my phone is and would like to report it missing.

After completing your report send it to ddallacosta@city.waltham.ma.us