LCPD Patch La Crosse Police Department Statement Form
SECTION 1: Form Information
Case Number:  *  
Enter only valid case numbers assigned by the La Crosse Police Department.  If you do not have a case number, or have not had one assigned to you, please fill out the complaint form by clicking here .  Upon completion you will receive a case number.
Date:  *  
Time:  *  

SECTION 2: Citizen Statement
I certify that the above information is true, correct, and complete.  I understand that falsifying a statement form may result in criminal charges.

SECTION 3: Name and Contact Info
Name:  *  
Date Of Birth:  
E-mail Address: *
Address:  *  
City, State, ZIP  *  
Phone Number  Area code + phone number *