Citizen’s Complaint Form Against Police
Questions marked by * are required.
1. Last Name: *
2. First Name: *
3. Middle Name:
4. Address: *
5. State: *
6. Zip: *
7. Cell Phone Number:
8. Other Number:
9. Email: *
10. Officer’s Name: *
11. Badge Number: *
12. Officer’s Vehicle Number: *
13. Date of Incident: *
14. Time of Incident: *
15. Time of Day: *

  • AM
  • PM
16. Location of incident: *
17. Please describe in detail what happened: *
18. Electronic Signature: *
19. Date: *