Citizen Complaint Form

LAST NAME

FIRST NAME

MIDDLE INITIAL

STREET ADDRESS

CITY

STATE

ZIP

PHONE

DATE OF BIRTH

EMPLOYER

EMPLOYER PHONE

EMPLOYEE NAME(Required)

Against Whom is the Complaint?

EMPLOYEE RANK

EMPLOYEE RADIO NUMBER

DATE OF COMPLAINT(Required)

Today’s Date

TIME OF COMPLAINT

Current Time

INCIDENT DATE(Required)

On what Date did the Incident occur?

INCIDENT TIME

At what Time did the Incident occur?

COMPLAINT(Required)

Please describe, in detail, the incident in concern.

ADDITIONAL COMPLAINT INFORMATION

ADDITIONAL COMPLAINT INFORMATION (2)

PRINTED NAME(Required)

Please type your name, or “Anonymous”, to affirm that everything stated above is true.

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