The State Fire Marshals Office
invites anyone with information regarding Insurance Fraud to
submit information about the crime through this website online tip form.
The information will be relayed directly to the Insurance Fraud Bureau. The information you provide will be maintained in the strictest
of confidence.
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* Required |
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COUNTY where the crime occurred: |
Select County!
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CITY where the crime occurred: |
Enter City!
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* ADDRESS
where the crime occurred: |
Enter Address!
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ZIP CODE where the crime
occurred: |
Invalid Zip Code!
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DATE the crime occurred
(As Known): |
(MM/DD/YYYY)
Enter Date Crime Occurred!
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Reporting Individual Information (Victim or Witness)
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Last Name: |
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First Name: |
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Middle Name: |
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Business Name: |
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Contact Telephone: |
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Contact Fax: |
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Email Address: |
Invalid Email Address! |
Mailing Address: |
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City: |
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State: |
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Zip Code: |
Invalid Zip Code! |
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Primary Suspect - Person Believed to Have Committed Crime
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Business Name: |
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* Last Name: |
Required
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* First Name: |
Required
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Middle Name: |
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Social Security Number: |
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Date of Birth: |
(MM/DD/YYYY) |
Race: |
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Sex: |
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Vehicle License Plate
Number: |
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Vehicle License Plate State |
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Vehicle Identification
Number: |
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Driver's License Number: |
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Fictitious Names, Alias,
Married or Maiden: |
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Distinguishing marks, scars,
tattoos, etc.: |
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Place of Employment, School,
or General Hangout: |
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Telephone: |
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Fax: |
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E-Mail Address: |
Invalid Email Address! |
Physical Address: |
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* City: |
Required
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* State: |
Required
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Zip Code: |
Invalid Zip Code! |
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Second Suspect - Person Believed to Have Committed Crime |
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Business Name: |
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Last Name: |
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First Name: |
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Middle Name: |
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Social Security Number: |
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Date of Birth: |
(MM/DD/YYYY) |
Race: |
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Sex: |
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Vehicle License Plate
Number: |
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Vehicle License Plate State: |
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Vehicle Identification
Number: |
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Driver's License Number: |
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Fictitious Names, Alias,
Married or Maiden: |
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Distinguishing marks, scars,
tattoos, etc.: |
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Place of Employment, School,
or General Hangout: |
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Telephone: |
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Fax: |
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E-Mail Address: |
Invalid Email Address! |
Physical Address: |
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City: |
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State: |
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Zip Code: |
Invalid Zip Code! |
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Additional Information |
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Is there additional information not already entered?
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* Summary as to why this is fraud: |
Enter Summary!
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Are you willing to submit additional information if it becomes available to you? |
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Is this information additional to a tip previously submitted? |
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If Yes, please enter Prior Tip Number: |
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For additional security, please check the checkbox below (and complete any puzzle prompts you may receive). |
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