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Request an AMBER Alert

This page is for Law Enforcement Officers only.

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

AMBER ALERT REQUEST FORM

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Date *

Time *

Agency/Department *

Officer's Name *

Officer's 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 Last Name *

Victim First Name *

Victim Middle Name

Date of Birth/Age *

Gender *

Height

Weight

Eyes

Race

Hair Color/Style

Clothing Description

Additional Information that may assist the public

Abduction Date *

Abduction Time

Abducted From/Location *

Direction of Travel

Destination

Suspect Last Name

Suspect First Name

Suspect Middle Name

Suspect Date of Birth/Age

Suspect Gender

Suspect Height

Suspect Weight

Suspect Eyes

Suspect Race

Suspect Hair Color/Style

Suspect Clothing Description

Additional Suspect Information

Vehicle Make

Vehicle Model

Vehicle Style

Vehicle Color

Vehicle Year

License Plate (Number and State)

Additional Information that may assist the public

Services

Request an AMBER Alert

Request an AMBER Alert

AMBER ALERT REQUEST FORM

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