Bicycle Theft Report Form

Notice: Online reports are not official reports.  Only the printed copy, signed by the reporting officer and containing a Department or Eugene Police issued case number are considered the official copies.  This online report form is intended to facilitate the report process by providing officers pertinent information about the incident in a timely manner so that an official report can be prepared and submitted through the reporting system.

Instructions

If you believe your bicycle was stolen, not borrowed by a friend or impounded, then fill out this form as completely and accurately as possible.

Before an official report can be filed, a DPS officer must be able to contact you to verify all the information you provided.  They may also have additional question regarding the incident.

Include your full name, address, and contact information.

If you are unsure of any details requested on this form, leave those fields blank.  Providing misleading or inaccurate information may slow the report filing process.

Please allow 48 hours for an officer to contact you for verification.

If you need a case number for insurance purposes, please advise the reporting officer at the time you're contacted so they may assist you.

Victim Personal Information

Name: 
(last, first MI)

Date of Birth:
(MM/DD/YY)

Street Address:

City:

State:

Zip:

Home Phone:

Work Phone: 

Preferred Call Time:

Email:

Incident Information

Location:

Date Occurred:

Time Occurred:

Last time Seen:
How was the bike stolen? (Describe)
Has this theft already been reported to the Eugene Police Department? No    Yes

Bicycle Information

UO Permit Number:

Serial Number:

Brand:

Model:
Frame Color:

Frame Size:

Speed:

Engraving:

Type:

 girls boys

Estimated Value:

Handlebar Style:

 racing  
regular  		 bmx  
pads  		 highrise  taped
Shocks: yes no

Grip Color:

Fenders:

 front  
back  		 plastic  
metal

Fender Color:

Seat Style:

Seat Color:

Material:
Reflectors: pedals  
seat  		 spokes (front)  
spokes (rear)
Brakes: one hand   two hand  pedal
Generator: head   tail
Wheels: wire    plastic   alloy
Color:
Tire Size:
Front Tire Color:
Back Tire Color:
Knobby?: yes   no
Racks: carrier 
basket  		 front  
rear 		 baby
Bags: handle bar    saddle
Toe Clips: yes    no
Stickers:

Locks
Locked? yes    no
Lock left @ Scene? yes    no
How was bike secured? (Describe)
Lock Type: cable  
chain  
U-lock  		 O-lock
pad--combination:

By submitting this report, you certify the information you have provided is true and correct to the best of your knowledge.  An officer will contact you within 48 hours to verify information.

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Bicycle Theft Report

Department of Public Safety

1319 East 15th Avenue
Eugene, OR  97403
Ph: 541.346.5444  Fax: 541.346.0947

University of Oregon

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