Skip Sub Navigation Justice for Fraud Victims Project Section Menu Justice for Fraud Victims Project Testimonials Report an Embezzlement In the News Do Not Edit: Do Not Edit: Do Not Edit: Don't Edit This Field: * = Required Fields * Who is the Victim? --Select One-- Me My Dependent Business Other Person Personal Information * First Name: * Middle Initial: * Last Name: * Address: * City: * State: Choose a State Alaska Alabama Arkansas Arizona California Canada Colorado Connecticut Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming * Contact Phone: * Type of Phone: --Select One-- Home Work Cell Message * Is your phone a hard of hearing device?: --Select One-- Yes No E-mail Address: * Contact Preference: --Select One-- Phone E-mail Business Information * Business Name: * Business Address: * Business Phone: Victim's Information * Victim's Full Name: * Victim's Address: * Victim's Phone: Location Where Incident Occurred * Do you have video or other evidence of the suspect and/or incident? No Yes Describe the video and/or other evidence: * Address: * City: * State: * Other: This Incident Occurred Between * Date: / / * Time: : AM PM To * Date: / / * Time: : AM PM Suspect Information * Do you have any suspect information? No Yes Witness Information * Have you spoken with others to ask them if they saw or heard anything? No Yes If "yes," how many witnesses were involved? Related Report Narrative * Explain, in chronological order, what happened. Who, What, When, Why and How. We will e-mail a response to you unless you specifically request a phone call and provide a valid phone number. This may take up to 3 business days. If you have not received a response after 3 business days, please call JFVP to determine the status of your information (contact information on main page.) Submit Clear Form
