Police Department Complaint Form

Your Name:(Required)

First Last

Phone(Required)

Your Email Address(Required)

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Work Address

Street Address Address Line 2 City State ZIP Code

Name(s) and/or Badge Number(s) involved:(Required)

Date of Occurrence:(Required)

Time of Occurrence:(Required)

Place of Occurrence:(Required)

Names, addresses and phone numbers of all known witnesses:

Statement of Allegation: Describe in your own words what occurred, including all incidents leading up to the matter of your complaint.:

You have the right to make a complaint against a police officer for any improper police conduct. California law requires this agency to have a procedure to investigate citizens’ complaints. You have the right to a written description of this procedure. This agency may find after investigation that there is not enough evidence to warrant action on your complaint. Even if that is the case, you have the right to make the complaint and have it investigated if you believe an officer behaved improperly. Citizen complaints and any reports or findings relating to complaints must be retained by this agency for at least five years. I have read and understand the above statement and hereby request an investigation to be initiated by the Chief of Police and state that the above facts are true and correct to the best of my knowledge and belief.

Type your name here if you agree to the above statement:(Required)

Date(Required)

Parent or Guardian Approval if complainant is a juvenile (type name)

First Last

Police Department Complaint Form

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