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Credit Card Fraud
Personal Information
First Name
First Name is required.
Last Name
Last Name is required.
Social Security #
The Port St. Lucie Police Department collects individual social security numbers in compliance with s. 119.071(5)(a), Florida Statutes.
SSN is required.
Email Address
Email is required.
Address
Address is required.
City
Zip
--Please Select--
34952
34953
34983
34984
34986
34987
Must match one of the Port Saint Lucie Zip Codes.
Zip Code is required.
Telephone
Race
--Please Select--
African American
American Indian/ Alaskan
Asian Indian
Camborian
Chinese
Filipino
Guamanian
Hawaiian
Hispanic/Latin/Mexican
Japenese
Korean
Laotian
Other
Other Asian
Pacific Islander
Portuguese
Samoan
Vietnamese
Caucasian
Ethnicity
--Please Select--
Hispanic Origin
Not Hispanic Origin
Unknown
Sex
--Please Select--
Male
Female
DOB
DOB is required.
Driver License #
Licensing State
--Please Select--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennesee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Credit Card Fraud Information
Incident Start Date
Start Date is required.
Incident End Date
End Date is required.
Incident Description
Description is required.
Cannot have more than 255 characters.
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