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2. Name
4. Mailing Address
6. City
7. State
8. Zip Code
10. Email Address
12. Employee Name
14. Occurence Date
    Occurence Date
16. Occurence Location
18. Complaint Details
20. Disclaimer

    Whoever knowingly makes a false complaint regarding the conduct of a law enforcement officer is subject to a Class A forfeiture. Anonymously filed complaints will be investigated, but you will not be notified of the outcome. Information submitted on this form will be sent via email. To protect sensitive information, do not submit the following information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, medical information, passport numbers, and passwords.

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

    This field is not part of the form submission.

24. Submit

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