Hernando County Sheriff's Online Loss Listing Form

ONLINE LOSS LISTING FORM

You may download a paper copy of this form HERE if preferred.

Step 1: Fill out case information you want to report losses for.

Case Number	Victims First Name	Victims Last Name	Telephone

INSTRUCTIONS: List type of item, give make, model, and serial number, or physical description of the item; i.e., size, color, material, design, men's, women's.

JEWELRY: identify any type of metal (yellow gold, silver, platinum, etc). Indicate the type, size, weight, shape, and color of stones, etc.

FURS: Indicate type of fur, color, size, style, maker or other identification.

GUNS: give manufacturer, model, serial number, caliber, length of barrel, color of weapon & stock, etc.

STEREO-TV: Indicate make, model, serial number, color, black & white, size of screen, etc.

CURRENCY: Indicate whether U.S. or FOREIGN notes and furnish denominations, etc.

BANK CHECKS/TRAVELER CHECKS/CREDIT CARDS: Identify by name or issuer or bank, give serial numbers or account numbers.

NOTE: ITEMS SHOULD BE REPORTED AT ESTIMATED FAIR MARKET VALUE, SUBJECT TO DEPRECIATION.

VALUES INDICATED SHOULD NOT INCLUDE RETAIL REPLACEMENT COST.

Step 2: Add items and property below including make/model and serial numbers if known.

Item	Name of Item	Make / Model	Serial #	Description	Value
1

Step 3: Add attachments such as pictures and documents below. (20 Mb max)

THERE ARE CURRENTLY NO ATTACHMENTS UPLOADED TO THIS FORM

YOU MAY UPLOAD UPTO 10 PER FORM.

File To Add

Associated Item

Brief Description

Upload

Step 4: Electronically Sign and Submit

Note:

FLORIDA STATUTE 837.06 FALSE OFFICIAL STATEMENTS: Whoever knowingly makes a false statement in writing with intent to mislead a public servant in the performance of his official duty shall be guilty of a MISDEMEANOR of the 2nd degree.

Name of Person Filling Out this Form:

I agree that the information in this electronic document is fully accurate to the best of my knowledge.