2. Name:*
4. Address:*
6. Phone number:*
8. Email address:
10. Date of the incident:*
12. Time of the incident:*
14. Location of the incident:*
16. Name of the officer or employee:*
    If you do not know the name, please list "unknown."
18. List any additional officers or employees involved:
20. Leave a detailed account of the event:*
    When describing the details, please try and answer who, what, when, where, why, and how. Please give a clear description of your complaint.
22. Would you like a call back?*
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24. 1. Receive an email copy of this form.
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26. Submit

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