Form Center

Complaint

2. CITIZEN COMPLAINT FORM
   Please fill out the form below as accurately and completely as possible. You do not have to leave identifying information such as your name and phone number, but if you do not leave that information we will not be able to follow up with you if we have additional questions once an investigation is started.

   Please fill out the form below as accurately and completely as possible. You do not have to leave identifying information such as your name and phone number, but if you do not leave that information we will not be able to follow up with you if we have additional questions once an investigation is started.

4. First Name

5. Middle Name

6. Last Name

7. Suffix
   -- Select One --Jr.Sr.IIIIIIV

9. Gender

   1. Male
   2. Female

10. Race

    1. Caucasian
    2. African American
    3. Asian & Pacific Islander
    4. American Indian or Inuit

11. Ethnicity

    1. Hispanic or Latino
    2. Not Hispanic or Latino

13. Date of Birth

    MM/DD/YYYY

14. Primary Phone Number

    999-999-9999

15. Secondary Phone Number

    999-999-9999

17. Address1

19. Address2

21. City

22. State

23. Zip

25. E-mail address (primary)

26. E-mail address (secondary)

28. Employer

29. Work address

30. Work phone number

34. Date & Time of Incident*
    Date & Time of Incident

    Date & Time of Incident

    Approximate date and time if exact time is unknown

35. Location of Incident*

    Address or approximate location

37. Type of Incident*
    -- Select One --Traffic stopTraffic crashArrestDomestic (dispute or assault)911 call/Call for ServiceSuspicious person or conditionAll other calls

38. Number of Officers*
    -- Select One --1234 or more

39. Enforcement Action*
    -- Select One --NoneVerbal WarningWritten WarningCitation or TicketPhysical Arrest

41. Nature of Complaint*

    1. Rude conduct toward me or a third party
    2. Use of foul or inappropriate language
    3. Unprofessional conduct toward me or a third party
    4. Vehicle operation not in compliance with traffic laws
    5. I believe the situation I was involved in was handled poorly or unfairly
    6. Other, please see narrative

    Please select the option or options that best describes the nature of your complaint. You may select more than one option.

43. Name of Officer

44. Physical description

46. Name of Officer

47. Physical description

49. Name of Officer

50. Physical description

52. Name and Contact Information of any witnesses

    Please fill out the name, approximate age and phone number of any witness to the events.

56. Description of incident*

    As clearly and concisely as possible, please describe the incident in question.

58. Signature of Complainant*

    Signature or your typed name will be sufficient for this block

59. Date and Time
    Date and Time

    Date and Time

Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit Submit and Print

* indicates a required field