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Complaint Form

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Steps

1. Step One This section is complete This section is incomplete
2. Your Information This section is complete This section is incomplete
3. Incident Information This section is complete This section is incomplete
4. Comments/Incident Information This section is complete This section is incomplete

Step One

Please provide as much Information as you can about the officer or police employee and their interaction with you.
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Your Information

First Name
Last Name
E-mail Address
Phone Number
Address1
Address2
City
State
Zip
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Incident Information

Date and Time of Incident
Date and Time of Incident
Date and Time of Incident
Location of Incident
Name of Officer/Employee #1
Name of Officer/Employee #2
Officer Description
If you don't know the officers name, please provide a brief description above.
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Comments/Incident Information

Comments
Please provide a detailed description of the incident.

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

This field is not part of the form submission.
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