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If you received a citation, fill in this box with your citation number.
Complete this section with your information.
First and last name.
Were there any witnesses? Complete the information below with the contact information for witnesses. If not, proceed to the next section.
What is the name of the location where this occurred?
What is the name of the officer or employee involved? If name is unknown, provide a short description.
Include a detailed description of the incident, circumstances, or conduct that you wish to report.
In the event that the information you provide is in regard to an allegation of wrongful conduct on the part of a police employee, please read and sign below:
Citizen's Statement: I believe that the facts I have provided are true and correct to the best of my knowledge. I agree to present this complaint in person to the appropriate investigative authority should the complaint result in a disciplinary proceeding against the officer(s) or other police employee(s). By typing your name below, you are signing that you agree to the above statements.
This field is not part of the form submission.
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