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2. Complainant Name
3. Email Address
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
13. Allegation
15. Complaint Against

    1. Public Service
    2. Employee
16. Incident Date
    Incident Date
18. Location
20. Officer Involved
22. Rank
23. Duty Status

    1. On-Duty
    2. Off-Duty
25. Allegation
27. Witness (if any)
29. Witness 1 (name, address, phone number)
31. Witness 2 (name, address, phone number)
33. Submission

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

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37. Submit

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