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2. Bicycle Theft Report
4. Contact us:
   St. Anthony Police Department
   3301 Silver Lake Road
   St. Anthony, MN 55418
   612-782-3350
5. 
7. Date and time of theft:*
   Date and time of theft:

   Date and time of theft:
8. Location of theft:*
   Note: must be in St. Anthony or Lauderdale.
10. Victim/ owner's full name:*
    First / middle / last
11. Date of birth*
    mm/dd/yy
13. Best contact phone number (cell and/or home number):*
15. Home address:*
17. City*
18. State*
19. Zip Code*
21. Parent's full name if victim is under the age of 18:
22. Parent's date of birth:
24. Brand of bicycle:
25. Style and size:
26. Color:
27. Model number:
29. Serial number:
30. Where was the bicycle purchase:
31. Date of purchase:
    Date of purchase:
32. Value:
34. *Was the bike outside or inside a structure? If the bike was inside a structure, this would be considered a burglary and you need to call 911.*
36. List below any special identifying marks or equipment added to the bicycle to aid in identification:
37. Please provide your email address to contact you if additional information is needed:
39. Electronic Signature and Agreement of person making report:

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
41. Electronic Signature
42. Date:
    Date:
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field