2. Location of Activity
3. Selling From Inside a Residence?

   1. Yes

   1. No
5. Name of Person Selling Drugs at Location
6. Type of Drugs Being Sold
8. Other People Selling/Active at Location
9. Most Active Time of Day
   When is there the most drug-related activity at this location?
11. Names of People Buying Drugs at Location
12. Owner of Property
14. Do you wish to be contacted?

    1. Yes

    1. No
16. First Name
17. Last Name
19. Phone Number
20. Email
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22. 1. Receive an email copy of this form.
23. Email address

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24. Submit

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