Office of the Chief Investigator Online Complaint

First Name

Last Name

Address 1

Address 2

City

State

Zip Code

Home Phone

Business Phone

Email Address

Date of Birth

Race

Gender

Female

Male

Description of Incident

Please enter as much detail as possible about the actions of officer(s).

Incident Description cannot be empty

Victim/Witness Information

Are you the victim of this incident complaint?

Yes

If not, what's your relationship to the person?

Witness A

First Name

Last Name

Address 1

Address 2

City

State

Zip Code

Home Phone

Alternate Phone

Email Address

Date of Birth

Race

Gender

Female

Male

Witness B

First Name

Last Name

Address 1

Address 2

City

State

Zip Code

Home Phone

Alternate

Email Address

Date of Birth

Race

Gender

Female

Male

Incident Information

Date of Incident

Date of Incident cannot be empty.

Time of Incident

Identify the police officer(s) complained of and also identify any officers at the scene who were present. If unknown, enter into the Description area (see below) the following: a physical description of the officer; type of duty performed; dressed in uniform or in civilian clothes; foot; motorcycle or auto patrol.

First Officer

First Name

Last Name

Badge Number

Precinct

Patrol Car Number

Description of Officer

Officer was:

In Uniform

Plain Clothed

Second Officer

First Name

Last Name

Badge Number

Precinct

Patrol Car Number

Description of Officer

Officer was:

In Uniform

Plain Clothed

Contact Source

Please contact me as soon as possible regarding this matter by

Home Phone

Alternate Phone

Postal Mail

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