Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
  1. Alliance Police Department Forgery Packet

    **Use this packet when the case involves a forgery. This could include many documents and transactions as well.**

  2. Forgery Packet - Internal Use
  4. (name/address of account holder) to release the financial information of the individual names below: 

  5. I authorize the information to be disclosed and discussed with the Alliance Police Department, the Box Butte County Attorney's Office, or the Nebraska Attorney General's Office. 

    The type and amount of information to be disclosed is as follows: 

  6. Copy of signature card or similar type document showing the account holder(s) signature.

    I understand this authorization will expire, without my express revocation, one year from the date of signing, or if I am a minor, one year from the date of signing or on the date I become an adult according to state law, whichever is earlier. I understand I may revoke the authorization at any time except to the extent that action has been based on this authorization. I understand the revocation must be in writing and presented to the provider named above. I understand my authorization is not needed under some conditions as previously explained pursuant to a notice received from the provider named above and any revocation in writing of this authorization does not affect the ability of the provider named above to disclose information otherwise allowed by law. I understand I have a right to a copy of this authorization.

    I understand that authorization for the disclosure of this financial information is voluntary and I can refuse to sign this authorization. I understand any disclosure of information carries with it the potential for re-disclosure and the information may not be protected by federal law or regulations.


    *Complete one form for EACH credit/debit card fraudulently used. 

  8. Card Information:
  9. Type of Card:
  10. Debit Card:
  11. Credit Card:
  12. Type of Fraud:
  13. Forgery Report Instructions

    *Alliance Police Department Staff Use Only

  14. 1. Have the involved victim/witness complete an attached Forgery Witness Form.
  15. 2. Place a checkmark next to any of the following evidence that may apply to this incident (attach any items that are checked):
  16. Incident Summary Form
  17. Incident Details:
  18. Forged Check Details:
  19. (indicate State)

  20. (e.g. reported stolen, contact with the account holders, quality of document, etc....) 


  21. Location & Witness Information:
  22. Suspect Check Information:
  23. (if known)

  24. (if known)

  25. (indicate State)

  26. (if applicable) 

  27. Description of Suspect & Vehicle:

    Complete any that are applicable 

  28. Sex:
  29. (Make, Model, Color, License Plate, etc.)

  30. Additional Information:
  31. What identification did the suspect present? (check type)?
  32. (e.g. reported as stolen, contact with account holder, quality of document, etc.) *BE DETAILED WITH YOUR EXPLANATION.

  33. Leave This Blank:

  34. This field is not part of the form submission.