Please Read the FAQ on Complaints Against Police Officers Before Filling Out This Form.

Is this a Complaint or a Commendation

Information About You

Email Address:
Last Name:
First Name, Middle Initial:

Optional Information

You need not fill in these blanks, but should consider doing so if you believe the information is relevant to this incident.

Race:
Sex:
DOB:

Contact Information

Home Address:
City, State, Zip:
Home Phone:
Business Address:
City, State, Zip:
Business Phone:

Incident Information

Date of Incident:
Time of Incident:
Location of Incident:

Incident Narrative

1st Officer's Badge #:		1st Officer's Name:
2nd Officer's Badge #:		2nd Officer's Name: