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Family Violence Offense ReportSubmit this form to DEPP only if an arrest was made (Print or type all entries. See other instructions on the reverse side of this form)1. Arrest Yes No 2. Case Number3.
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This form is submitted to the appropriate regulatory agency or organization.
The form must be filed by individuals or entities as required by law or regulations.
The form can be filled out electronically or manually, following the instructions provided by the regulatory agency.
The purpose of this form is to report specific information or data to the regulatory agency for monitoring or compliance purposes.
The form may require reporting of financial, operational, or other relevant data as specified by the regulatory agency.
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