Request To Enter Missing Person Into Database — roomonetwentyone

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Request To Add Missing Person To Database

PLEASE READ PRIOR TO COMPLETING THE FORM *

NOT ALL OF THE INFORMATION ENTERED IN THIS FORM IS POSTED FOR PUBLIC VIEW. THE ONLY INFORMATION PROVIDED TO THE PUBLIC ARE DETAILS PERTINENT TO IDENTIFYING A MISSING PERSON. WE DO NOT LIST PERSONAL CONTACT INFO FOR PUBLIC VIEW. THIS IS TO PROTECT YOUR PRIVACY, AS WELL AS PROTECTING YOU FROM INDIVIDUALS WITH ULTERIOR MOTIVES. IF YOU PREFER TO LIST YOUR CONTACT INFO, THAT IS YOUR CHOICE AND DONE SO AT YOUR OWN RISK

PLEASE REDACT MY CONTACT INFO

YOU HAVE MY PERMISSION TO PUBLICIZE MY CONTACT INFO

Your Name *

This info will NOT be made public. It is only required so we can contact you for updates or to relay case related information. We do not give out names or contact info to anyone.

First Name

Last Name

Contact Info *

Please provide a manner in which to contact you. Phone or email. This infomation will NOT be available to the public. It is only for us to contact you for updates.

What Is Your Relationship To The Missing Person *

Friend

Family

Concerned Citizen

Has A Police Report Been Filed? *

We do NOT require a police report to be filed to enter your missing person into our database

Yes

No

If a police report was filed, please specify Department and Case Number *

If no report has been filed, put N/A

City/State/Location Last Known *

Enter City, State and Location Details Last Known

Date Of Last Contact/Date Last Seen *

Please enter contact date and manner of contact and/or date last seen and where and by whom.

Missing Person Full Name *

Enter Missing Person's Full Name

Missing Person Ethnicity *

Please enter ethnictiy of the missing person. Example; White, Asian, African American, Hispanic, American Indian ( enter tribe if known), Alaska Native, Hawaiian/Pacific Islander/Unknown

Missing Person's Age *

Please provide Date Of Birth - Current Age - And age at time of disappearance.

Height/Weight *

If you do not know the person's exact Height/Weight and are giving an estimation, please specify it is "approximate"

Describe Missing Person's Hair *

Include: Hair on the head, and any facial hair: Color, Length, Style, Dyed different colors, extensions, weaves, wig, etc

Eye Color/Contacts/Glasses *

Enter eye color, any glasses, contacts, and any additional details that may apply

Identifying Markings *

This includes any scars. tattoos, moles. freckles, etc., that will help in identifying the missing person.

Clothing Description *

Please describe clothing. If unknown, enter "unknown"

Special Health/Mental Health/Substance Abuse Issues *

Please list any medical, mental health issues, substance abuse issues ( we won't publicize substance abuse issues if you prefer to keep info private) Does the person require daily medication? Any medical devices?

Missing Limbs, Toes, Fingers, Prosthetic Devices *

Please specify if the person ismissing , Toes, Fingers, Legs, Arms, etc., and/or any Prosthetic Devices

Transportation Information *

If missing person was last seen in a vehicle, or if their vehicle is also missing, please list as much info as possible. In this area you can also enter any known methods of transportation, ie., bus, cab, frequently used uber, etc.

Circumstances of Disappearance *

Please be as detailed as possible so the correct information is circulated. Utilize the Where, What, When, How method.

Additional Details or Comments

Would you like a flyer constructed for the missing person?

Yes

No

FINAL NOTE *

To the best of my knowledge, all the entered information is accurate and complete.

Yes. My entry is complete.

No, I am missing information, please hold entry.

PHOTO SUBMISSION *

Please submit the most current photos of the missing person. If possible, include photos that may show any tattoos. scars, etc. **Please try to submit photos that have a clear view of the persons face. If possible, avoid photos with "snapchat" filters or other app filters. If this is all you have available, you may submit them. PLEASE SUBMIT PHOTOS TO: EMAIL: databaseroom121 @gmail.com SEND THEM IN A PRIVATE MESSAGE TO OUR FB PAGE. LINK AVAILABLE ON OUR CONTACT TAB WHEN SUBMITTING PHOTOS Include: Your name Missing Person's Name Date of Form Submission

Sending Photos via Email

Sending Photos via FB message

I Have No Photos Of The Missing Person

Thank you for submiting your entry.

Please email photos of the missing person to:

requestform121@gmail.com

OR

You may send them in a private message to our FB page

Please include:

Your name

Missing Person’s name

Date of completed request

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