This information is required for verification and will be kept confidential.
1. Your Roblox Username & User ID*
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Format: Username:1434030530
2. Your Discord Username & ID*
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Format: Username#924175524438343721
Section 2: Offender's Information
Please provide as much information as you can to help us identify the correct user.
3. Offender's Roblox Username*
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JakJak28_TheGoat.
4. Offender's Discord Username (if applicable)
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This is optional but highly recommended if the incident occurred on Discord.
Section 3: Incident Details
Provide a clear and factual account of the events.
5. Date and Approximate Time of Incident*
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October 3rd 2026 at 5:29PM
6. Location of Incident*
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in the 5 Hour server at the gas station.
7. Detailed Description of Events*
I8. Specific Rule(s) Violated*
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Context leading up to the incident: I was sitting at the gas station. Approximately two minutes before the incident, the offender pulled up next to me, then drove away.
Actions taken by the offender: The offender returned and shot me without reason. There was no interaction or provocation on my part prior to the shooting.
Quoted chat messages: (No relevant chat messages occurred prior to the incident.)
By submitting this report, I confirm that the information provided is true and accurate to the best of my knowledge. I understand that submitting a deliberately false or malicious report is a violation of community rules and may result in disciplinary action against my own account.
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ection 1: Your Information (Reporter)
This information is required for verification and will be kept confidential.
1. Your Roblox Username & User ID*
2. Your Discord Username & ID*
Section 2: Offender's Information
Please provide as much information as you can to help us identify the correct user.
3. Offender's Roblox Username*
4. Offender's Discord Username (if applicable)
Section 3: Incident Details
Provide a clear and factual account of the events.
5. Date and Approximate Time of Incident*
6. Location of Incident*
7. Detailed Description of Events*
I8. Specific Rule(s) Violated*
Section 4: Evidence
EVIDENCE IS MANDATORY.
9. Evidence Links*
Section 5: Acknowledgment
10. Confirmation*