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2. 

3. COMMUNITY POLICE REVIEW COMMISSION

   COMPLAINT AGAINST POLICE PERSONNEL

7. COMPLAINANT INFORMATION:
8. COMPLAINT INFORMATION:
10. First Name*
11. Last Name*
12. Type of Complaint (Check all that apply)*

    1. Unnecessary Force
    2. Excessive Force
    3. Discrimination
    4. Sexual Harassment/Sexual Assault
    5. Appeal
14. Date of Birth*
15. ID/DL #
16. Date of Incident*
    Date of Incident
17. Time of Incident*
    Time of Incident
19. Primary Phone #*
20. Secondary Phone #
21. Place of Incident*
23. Are you represented by an attorney for this incident*

    1. YES
    2. NO
25. Best Time to Call (Check all that apply)*

    1. 9 AM - 12 PM
    2. 12 PM - 5 PM
    3. 5 PM - 9 PM
26. Medical Release Signed*

    1. Yes
    2. No
    3. N/A
27. Activity Being Performed (Check all that apply)*

    1. Arrest
    2. Booking
    3. Custody
    4. Detention
    5. Investigation
    6. Patrol
    7. Transportation
    8. Warrant Stop
    9. Other
28. Specify Other*
36. Home Address *
37. Involved Officer Name, Rank, and Badge#:
39. Is your Home Address the same as your Mailing Address?*

    1. Yes
    2. No
40. Involved Officer Name, Rank, and Badge#:
42. Mailing Address*
43. Criminal Case Pending:

    1. Yes
    2. No
44. Interview Taped

    1. Yes
    2. No
46. Email Address*
47. Injuries

    1. None
    2. Visible
    3. Claimed
49. Please list contact information for any witnesses:
51. First and Last Name:
52. First and Last Name:
54. Phone Number:
55. Phone Number
57. Home Address:
58. Home Address:
60. Narrative of Complaint/Incident:
Leave This Blank:


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

    This field is not part of the form submission.

64. Submit

* indicates a required field