Citizen Complaint -

COMPLAINANT INFORMATION

Name:

Date of Birth:

Address:

City:

State:

Business Phone:

Best Time to Contact:

E-mail:

Repeat to confirm

Officer #1

Officer Name:

Badge #

Vehicle #

Please provide a physical description of the officer:

Officer #2

Officer Name:

Badge #

Vehicle #

Please provide a physical description of the officer:

Officer #3

Officer Name:

Badge #

Vehicle #

Please provide a physical description of the officer:

VICTIM/WITNESS INFORMATION

Did you witness this incident?

Yes No

If you are filing a complaint on behalf of someone else, what is your relationship, if any to the person(s):

Parent Relative Child Spouse Guardian Fiend Other

Victim/Witness #1

Please provide as much of the following information as you can about the person(s) on whose behalf the complaint is filed and any witness (es) to the incident:

Is this person a:

Victim Witness

Name:

Address:

City:

State:

Zip Code:

Telephone:

Victim/Witness #2

Is this person a:

Victim Witness

Name:

Address:

City:

State:

Zip Code:

Telephone:

Victim/Witness #3

Is this person a:

Victim Witness

Name:

Address:

City:

State:

Zip Code:

Telephone:

INFORMATION ABOUT THE INCIDENT

Date:

Time:

Location:

Case Number:

Please provide details of the incident:

Citizen Complaint

COMPLAINANT INFORMATION

INFORMATION ABOUT THE OFFICER(S) INVOLVED IN THE INCIDENT

VICTIM/WITNESS INFORMATION

INFORMATION ABOUT THE INCIDENT

COMPLAINANT INFORMATION

Name:

Date of Birth:

Address:

City:

State:

Business Phone:

Best Time to Contact:

E-mail:

Repeat to confirm

Officer #1

Officer Name:

Badge #

Vehicle #

Please provide a physical description of the officer:

Officer #2

Officer Name:

Badge #

Vehicle #

Please provide a physical description of the officer:

Officer #3

Officer Name:

Badge #

Vehicle #

Please provide a physical description of the officer:

VICTIM/WITNESS INFORMATION

Did you witness this incident?

If you are filing a complaint on behalf of someone else, what is your relationship, if any to the person(s):

Victim/Witness #1

Is this person a:

Name:

Address:

City:

State:

Zip Code:

Telephone:

Victim/Witness #2

Is this person a:

Name:

Address:

City:

State:

Zip Code:

Telephone:

Victim/Witness #3

Is this person a:

Name:

Address:

City:

State:

Zip Code:

Telephone:

INFORMATION ABOUT THE INCIDENT

Date:

Time:

Location:

Case Number:

Please provide details of the incident: