Fillable Civilian Complaint Form (Page 2 of 3) in pdf

Civilian Complaint Form Page 2

Download a blank fillable Civilian Complaint Form in PDF format just by clicking the "DOWNLOAD PDF" button.

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Complete Civilian Complaint Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

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1. Complainant’s Last Name

First

__________________________________________________________________

2. Business Telephone Number

___________________________________________________________________

3. Complainant’s Address

Apt. #

___________________________________________________________________

4. Residence Telephone Number

___________________________________________________________________

5. Sex: Male

Female

6. Age ___

6a. Date of Birth ______________

7. Date & Time Reported __________________

8. Day, Date & Time of Occurrence: _________________________________

9. Description of Roosevelt Island Public Safety Dept. Personnel involved:

Sex

Color

Age

Height

Weight

Shield Number and

Name (if known)

10.

Details of Incident and/or Basis for Complaint:

______________________________________________________________________________

__________________________________

Complainant’s Signature

====================================================================

Civilian Complaint Form Page 2

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