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Citizen Complaint Form

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Steps

1. CITIZEN COMPLAINT This section is complete This section is incomplete
2. INTERNAL USE ONLY This section is complete This section is incomplete

CITIZEN COMPLAINT

Incident Information
Date and Time of Incident
Date and Time of Incident
Date and Time of Incident
Location of Incident
Nature/Type of Incident
Officer's Name
Badge #
Car #
Unit #
Complainant Information
Name (Last, First, MI)
Sex
Race
Social Security #
Date of Birth
Date of Birth
Written Statement
1. Yes
2. No
Taped Statement
1. Yes
2. No
Home Address
City
State
Zip Code
Phone Number
Email Address
Employer
Occupation
Employer Address
Phone #
Witness Information
Please include information related to a key witness, if applicable.
Witness #1 Name
Sex
Race
Address
Phone Number
Email Address
Witness #1 Date of Birth
Witness #1 Date of Birth
Written Statement
1. Yes
2. No
Taped Statement
1. Yes
2. No
Witness #2 Name
Sex
Race
Address
Phone Number
Email Address
Witness #2 Date of Birth
Witness #2 Date of Birth
Written Statement
1. Yes
2. No
Taped Statement
1. Yes
2. No
Details of the incident or complaint:
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, 3) you may still be required to provide a traditional signature at a later date, and 4) that all information on this report is accurate and true.
1. I agree.
Electronic Signature
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INTERNAL USE ONLY

Officers Involved
Receiving Officers Observations
Chief of Police Use Only

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