Unlicensed Activity Report Form

Unlicensed Activity Report Form

This form is provided to report suspected unlicensed activity to local law enforcement agencies.
Instructions for Use

This form is intended to assist individuals in documenting suspected unlicensed activity for criminal referral to local law enforcement. This form may accompany photos, video, or other evidence.

Completion of this form does not constitute filing a criminal complaint but may assist law enforcement in establishing probable cause.
Reporter Information
Contact Person
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Suspected Individual or Entity Information
Name of Individual or Business
Known Aliases / DBAs (if any)
Business Address or Known Operating Location
Phone Number / Website / Social Media (if known)
Description of Suspected Unlicensed Activity
Type(s) of Service Being Provided

Other
Summary of Activity Observed
Describe what was observed, including dates, times, and ongoing nature of operations
Location(s) of Activity
Frequency / Duration of Activity
Statutory Reference (for law enforcement awareness)

Minnesota Statute 326.3381 requires a license to engage in private detective or protective agent services in the State of Minnesota.

Violation of this statute is a Gross Misdemeanor.
Law Enforcement Agency Information

List the agency you are referring this to
Agency Name
Date Submitted

MonthDayYear
Date
Method of Submission

Other
Additional Notes (if any)
Reporting Party Signature
Should be Empty:

Unlicensed Activity Report Form

Reporter Information

Suspected Individual or Entity Information

Description of Suspected Unlicensed Activity

Law Enforcement Agency Information