Citizen Complaint Form

Contact Information:

Name

Date of Birth

Race (Optional)

Telephone Number

Email Address (Copy of Complaint will be forwarded to you for your records)

Home Address

State

Zip Code

Complaint Type and Summary:

Improper ActionRudenessDrivingArrest or StopHarassmentPoor CommunicationsUnprofessional ActionPolice Use of ForceOther (Explain in Summary)
Case Number or Call Number (if known)

Location of Incident

Date of Incident

Summary of Incident

Officers and/or Employees Involved:

1.

Name

Badge or Employee Number

Car Number or Vehicle Description

Description of officer if above information not known

2.

Name

Badge or Employee Number

Car Number or Vehicle Description

Description of officer if above information not known

3.

Name

Badge or Employee Number

Car Number or Vehicle Description

Description of officer if above information not known

Witness Information

1.

Name

Phone Number

Address

2.

Name

Phone Number

Address

3.

Name

Phone Number

Address

By clicking, I do hereby affirm that the above allegations made by me in this citizen's complaint report are to the best of my knowledge and belief, true, and based on fact.