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2. Complaint Form
4. Your Name*
5. Your Sex*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone*
14. Alternate Phone
16. Email*
18. Incident Location*
20. Personnel Involved*
22. Rank*
24. Badge Number*
26. Witness 1*
27. Witness Phone Number*
29. Witness Address*
31. Witness 2*
32. Witness Phone Number*
34. Witness Address*
36. Story to Explain the Complaint
38. Note:

    Completing this form will still require a physical signature.

40. Acknowledgement*

    1. I acknowledge the statement on this form.

    Perjury Statement (PDF)

Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field