Mail Theft And Vandalism Complaint Form printable pdf download

Mail Theft And Vandalism Complaint Form

Mail the Completed Form to:

Postal Inspector In Charge

415 1st Ave N

Seattle

98109

1. Post Office (Including Station or Unit and ZIP + 6)

Mail Theft and

Perrinville: 7601 Olympic View Drive

Vandalism Complaint

Edmonds, WA 98026-9998

(425)670-2710

2. Name of Complainant

Street Address

Apt. No.

Home Telephone (Include Area Code)

Work Telephone (Include Area Code)

City, State, and ZIP + 4

3. Nature of Complaint

Damage

Mail

False Change

Theft of Mail

to Mailbox

Tampering

Mail Rifling

of Address

Occurrence Date and Hour

Fire in Mailbox

Other (Describe)

4. Contents of Mail Stolen

ATP

Correspondence

Currency

Check

Bank Statement

Credit Card

(Food stamps card)

Credit Card

Statement

Other (Describe)

5. Type of Delivery

Rural

Apt. House; No. of Families__________

Private Home

P.O. Box

Rooming House

Office Building

or HCR

Hotel/Hospital

Other (Describe)

6. Type of Receptacle

Locked?

Approved

Door Slot

NDCBU

Yes

Apartment Panel

Collection

Residence

Desk Service

Rural Type

Combination

7. Particulars of Stolen Check

01) Personal

07) ATP

04) State

06) Money Order

02) Commercial

03) Local

05) Federal

Sender's Name and Address

Payee (If different from complainant)

Amount

Check No.

Symbol No. (If U.S.Treasury)

Date

Bank on Which Drawn

Maker of Check

8. Purpose for Which Check Issued

If Check or Money Order

Was Cashed, Obtain

Particulars

(Date, place, person

accepting it, etc.)

10. Suspects (Name, address, physical description, car description and license no.)

11. Were Police Notified?

Yes (If "Yes," give Police Report No.:______________________)

No ( If "No," instruct complainant to do so.)

12. Remarks (Continue on reverse, if necessary)

14. Complaint Received by (Signature)

13. Date of Complaint

2016

PS Form

, March 1994

Mail Theft And Vandalism Complaint Form

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