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:

Discription of Purse/Wallet:

Contents in Purse/Wallet.. (I.D. bank cards)

Last Time seen:

Have you notified and cancelled credit cards?

Value of item stolen.

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

  E-mail: jhay@yahoo.com

  First Name: Jane

  Last Name:  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

I would like to report my wallet missing, I lost it in the Shaws parking lot at 1070 Lexington St. around 2030hrs on 11/19.  I checked with Shaws but was unable to locate the wallet.

The wallet was a bright green 9-West wallet value 100.00 with the following contents:

- Bank of America ATM card
- New York & Co. Credit Card
- MA driver's license
- BJ's card
- Blockbuster card

I’ve contacted and cancel my credit cards.  I would like a report on file so I can be notified if the wallet was located.

e-mail report to ddallacosta@city.waltham.ma.us