2. This form is used to supply additional information or ask questions regarding the status of your case being worked by the Loudoun County Sheriff's Office.
6. Your Information
8. First Name*
9. Last Name*
11. Contact Phone Number *
12. Alternate Phone Number
13. Email*
15. Case Number (if known)
16. Deputy Assigned (if known)
17. Date of Incident
    Date of Incident
21. Please supply your question or information here*
25. Affirmation
    I do hereby affirm that the foregoing information provided by me is true and complete to the best of my knowledge and belief. I understand that any false or misleading statements, accusations or allegations made by me in relation to this complaint, either orally or in writing, may subject me to civil action and/or criminal prosecution.
    
    By submitting this form, you are agreeing to the above statement.
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27. 1. Receive an email copy of this form.
28. Email address

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29. Submit Submit and Print

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