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AMBER Alert Request Form

Submit this form by clicking "Submit" when complete, then call Nebraska State Patrol Dispatch at (402) 479-4921

AMBER ALERT

CHILD ENDANGERMENT / ABDUCTION EMERGENCY NOTIFICATION

 

Are you requesting an AMBER Alert Yes

AGENCY INFORMATION

Date     Time 

Agency 

Officer's Name 

Officer Phone # 

Officer Email Address 

Phone number for public to call 

                                        

Is the abducted child 17 or younger? Yes

Do you have reason to believe that the child is in danger of serious bodily harm or death? Yes

Is there enough information for the public to assist in locating the abducted child? Yes

 

VICTIM (CHILD) INFORMATION

Name: Last  First  Middle 

DOB/Age  Gender 

Height  Weight  Eyes 

Race  Hair Color/Style  

Clothing Description  Additional Information 

Obtain a photograph of the child (if available) and email to amber.alert@nebraska.gov.

 

ABDUCTION INFORMATION

Date  Time  Location 

Direction of Travel  Destination 

Additional Information 

 

SUSPECT INFORMATION

Name: Last  First  Middle 

DOB/Age  Gender

Height  Weight  Eyes 

Race  Hair Color/Style 

Clothing Description  Additional Information 

 

VEHICLE INFORMATION (If Involved)

Make  Model  Style 

Color  Year  

License Plate (Number & State)   

Additional Information 

 

This form contains CONFIDENTIAL INFORMATION which may be legally priviledged and is intended only for the use of the individual or entity to which it is addressed. Unauthorized disclosure or dissemination may be prohibited by state and federal statutes. If you have received this communication in error, please contact the sender immediately. 

 

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Nebraska State Patrol

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Nebraska State Patrol1600 Highway 2Lincoln, NE  68502

PH: 402-471-4545

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