Police Complaint Form
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3The Town of ________________________ Citizens' Police Complaint Form**
Police Department
Chief or Deputy Chief of Police
Name ______________________________________ Title __________________________________________
Address: ___________________________________________________________________________________
Address: ____________________________________________________________________________
)_
____________________________
Date: ___________________________(
Telephone:
important
NCCF NO.__________________________________________________________________________
Office Staff only
Complaint Form/Instructions:
1. Type or Print clearly in dark ink
2. Complete entire form (incomplete or unclear forms will be returned)
3.
Enclose copies (not originals of important papers concerning your complaint.)
Person Filing Complaint
_______________________________________________________________________
Name Date of Birth
_______________________________________________________________________
Address
_______________________________________________________________________
Address
_______________________________________________________________________
Town State County Zip Code
_______________________________________________________________________
Home Telephone Business Telephone
_______________________________________________________________________
.
Person/Officer/Entity you are complaining about Badge No./Car No
_______________________________________________________________________
Person/Officer/Entity you are complaining about Badge No/Car No.
_______________________________________________________________________
Person/Officer/Entity you are complaining about Badge No./Car No.
_______________________________________________________________________
Date of Incident Time of Incident
_______________________________________________________________________
Location of Incident
_______________________________________________________________________
Please check statements that applies
Officer(s) did not conduct his or herself in a professional matter (violated civil right(s)
Officer(s) used excessive force
Officer(s) communicated bias based upon race, gender, national origin, religion, sexual orientation or
.
disability
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Parent category: Legal