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2. Remain Anonymous?*

   1. Yes
   2. No
4. Your First Name
5. Your Last Name
7. Your Email Address
8. Your Phone Number
10. Describe the Tip You Wish to Share*
12. Person of Interest's Name
13. Male or Female

    1. Male
    2. Female
15. Race

    1. White
    2. Black
    3. Hispanic
    4. Asian
    5. Other
16. Facebook Profile Name
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18. 1. Receive an email copy of this form.
19. Email address

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20. Submit

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