Police Complaint Form (Page 2 of 3) in pdf

Please check statements that applies



fficer(s) used excessive force



__________________________________________________________

Other, Explain

_______________________________________________________________________

*Signature of Complainant (or parent/guardian if Complainant is under 18)

Please explain in your own words the particular description of the acts and conduct of officers(s) which gives rise

to your complain.

_______________________________________________________________________

_________________________________________________

Attach additional sheets if necessary

*Signature of Complainant (or parent/guardian if Complainant is under 18

Witnesses to this incident (important)

_______________________________________________________________________

Name Contact Telephone

_______________________________________________________________________

Address

_______________________________________________________________________

Name Contact Telephone

_______________________________________________________________________

Address

_______________________________________________________________________

Name Contact Telephone

_______________________________________________________________________

Address

Important:Important:Important:important:Important:Important:Important:Important

1. Make copies (3) 1 for yourself, 1 to file with Chief or Deputy Chief of police, 1 with a reliable party(s) of your

choice i.e. your Attorney or a witness.

2. File all papers on time (within 90 days of incident)

3. *Sign your statement in front of reliable witness(s). (Excepted but not necessary an, attorney, notary public,

justice of the peace).

* The Police Department should respond in writing to this complaint within 30 days of receiving this

complaint. Check with department for policy. ** This form is not a legal document. It is to be used to help

formulate and collect information. Check with the dept that your complaint will be submitted for legal

form(s).

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Police Complaint Form Page 2