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[FBI NIBRS Based Form]

This report is authorized by law Title 28, Section 534, United States Code. Your cooperation in using this form to list data pertaining to all homicides reported on your
Return A will assist the FBI in compiling comprehensive, accurate data regarding this important classification on a timely basis. Within 30 days of the homicide
incident, the chief law enforcement officer for an agency must submit a completed form to the Minnesota Bureau of Criminal Apprehension.

Submit Report Online at:

Send Questions to: [email protected]

REPORT ONLY ONE INCIDENT PER FORM- Report all homicides for this incident (case#) on this form.
*Agency ORI:

*Agency Name:

*Date of Incident: (mm/dd/yyyy)

*Incident/Case Number:

(8 characters)

No The date given above is the actual incident date of the Homicide, and not the date the incident was reported.


*Was there a death in this incident?


Do any of the