Missing Person Affidavit/missing Child/juvenile Checklist - Orlando Police Department
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1
2CASE NUMBER ______________________
ATTACH
ORLANDO POLICE DEPARTMENT
MOST
RECENT
PHOTO HERE
MISSING PERSON AFFIDAVIT
I, the undersigned, swear or affirm the following person is missing from (location)
on the
day of
month
year.
The person is described as follows:
Race
DOB
Sex
Ht.
Wt.
Hair
Eyes
Remarks (scars, tattoos, piercings, etc.)
If person is a juvenile, this section must be completed.
Name (First)
(Middle)
(Last)
(Suffix)
Aliases and/or Nicknames
Social Security #
Driver’s License #
Child/Juvenile Birth Information:
City
County
State
Last Seen Wearing
Name of Current School
Employer’s Name/Address
CURRENT Home Address
CURRENT Home Phone
Guardian’s Name, Address, and all Phone Numbers
Mother’s Name, Address, and all Phone Numbers
Father’s Name, Address, and all Phone Numbers
I,
, am the parent, legal guardian, custodian, or am otherwise authorized
to report
, a minor child/juvenile/adult, to the Orlando Police Department as
missing. I hereby authorize the Orlando Police Department, its officers and employees, in the conduct of
their investigation, to release, publish and distribute photographs and other information about this missing
person to other law enforcement agencies, the media, public and private missing persons organizations,
and any other person, agency, or group.
I further swear or affirm that I do not know the whereabouts of
and that I am authorized to report this person as missing, as the parent, guardian, custodian, or otherwise
authorized reporter.
I understand that giving false information to a law enforcement agency is a violation of City Code Chapter
43.16 for which I may be subject to prosecution.
Signed
Witness
Attach to Incident Offense Report
ENSURE COMPLETION OF PAGE 2
PAGE 1 OF 2
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