Teton County Sheriff’s Office
Sheriff Tony Liford
230 N Main St., #160, Driggs, ID 83422 – Phone: (208) 354-2323 – Fax: (208) 354-8028 – Email: sheriffdocs@co.teton.id.us
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CONFIDENTIAL INFORMATION – FOR INVESTIGATION PURPOSES ONLY
(Rev.1 02/17)
INCIDENT REPORT / STATEMENT FROM
Instructions: Please complete this form, sign and date the back page and return it to the Teton County Sheriff's office as soon as
possible, or return it to the deputy assigned to your case. The information you provide will be used to understand what occurred,
organize the investigative case, and determine where evidence might be found.
All information provided will remain confidential
and used only in the case investigation.
Case Number (provided by deputy):___________________________
Case Information
Date/Time of Incident: __________________________Location of Incident: _________________________________________
Type of Incident: ________________________________________________________________________________________
Reporting Party/Victim Information
Full Name: ________________________________________________________ Date of Birth: ___________
Driver’s License State: ____ Driver’s License #: ______________
Physical Address: _____________________________________ City: ____________ State: ___ Zip: _______
Mailing Address: ______________________________________ City: ____________ State: ___ Zip: _______
Home Phone #: __________________ Cell Phone #: __________________ Work #: ____________________
Email: __________________________________________________________________________________
Witness/Other Involved Person Information
Full Name: ________________________________________________________ Date of Birth: ___________
Physical Address: _____________________________________ City: ____________ State: ___ Zip: _______
Home Phone #: __________________ Cell Phone #: __________________ Work #: ____________________
Suspect/Other Person Information
Full Name: ________________________________________________________ Date of Birth: ___________
Physical Description: Sex: ____ Race: ________ Ethnicity: __________ Hgt: _____ Wgt: _______ Build: ______
Hair: _______ Eye: _______ Scars, Marks, or Tattoos: ____________________________________________
Clothing: _________________________________________________________________________________
Vehicle: _________________________________________________________________________________
Physical Address: _____________________________________ City: ____________ State: ___ Zip: _______
Home Phone #: __________________ Cell Phone #: __________________ Work #: ____________________
Name of Employer/Business: ________________________________________________________________
Statement:
Please describe what occurred: ________________________________________________________________________
______________________________________________________________________________(Continue on next page)
