DVFRB Case Referral

DVFRB Case Referral Form 2026

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
Name of the person referring the case*
You will be contacted via this email address for followup about your submission
Address of person referring the case*
Example: neighbor, sister, brother, friend, etc.
Connection to the case being referred

Is the case being referred closed?
If it did not occur in the city limits then put “county”
MM slash DD slash YYYY
Name of the victim of the fatality/near fatality*
MM slash DD slash YYYY
Name of the perpetrator of the fatality/near fatality*
MM slash DD slash YYYY
If known, what agencies/systems were the victim and/or perpetrator involved with prior to the fatality/near fatality?
1,000 word limit
MM slash DD slash YYYY

Mailing Address

Mississippi Department of Public Safety
P.O. Box 958
Jackson, MS 39205

(601) 987-1212

Physical Address

Mississippi Deptment of Public Safety Headquarters
1900 East Woodrow Wilson Avenue
Jackson, MS 39216

Office Hours

Weekdays: 8 a.m. to 5 p.m.
Closed Weekends