Civilian Complaint Form

2. Complainants information
6. Name
7. Email Address
9. Address
11. City
12. State
13. Zip Code
15. Phone Number
16. Fax Number
20. Date / Time of Incident
    Date / Time of Incident

    Date / Time of Incident
22. Address where incident occured
24. Address
26. City
27. State
28. Zip Code
30. Name of Person you are complaining about, if known
32. First Name
33. Last Name
35. Did you report this to other officers?

    1. Yes
    2. No
36. If so, Whom?
38. Person(s) who actually saw the event (including yourself)
40. Summary of Occurrence
42. Submit Form

    1. Yes

    1. No
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit Submit and Print

* indicates a required field