District Police - Public Citizen Complaint Form

District Police Citizen Complaint Form

YOUR RIGHT TO MAKE A COMPLAINT The Department accepts and investigates complaints from members of the public. A related arrest, citation, or court matter does not prevent you from filing a complaint. The timing of investigative steps may be coordinated with related proceedings as permitted by law. Questions may be directed to the Police Lieutenant at (209) 954-5000.
- Disclaimer: Although you are NOT required to provide any contact information, we need to have some way to contact you with any results from the request.
- Name
  
  First NameMiddle NameLast Name
- Home Phone Number
- Cell Phone Number
- Other Phone Number
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Date / Time Incident Occurred
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
  Hour MinutesAM/PM Option
- Location of Occurance
- Report / Citation Number
- Police Officer / Employee Name (s) if known
- Witness 1 - Name
- Witness 1 - Contact Information
- Witness 2 - Name
- Witness 2 - Contact Information
- Describe what occurred and why you are making this complaint. Attach additional pages or documents if needed.
- Upload Attachments
  
  Cancelof
- Profiling Alleged? (Yes / No)
- If Yes, List Type(s): race, color, ethnicity, national origin, age, religion, gender identity/expression, sexual orientation, disability
- SUBMISSION AND SIGNATURE
  
  You may submit this form even if you do not know an employee's name or cannot complete every field. Your signature is requested but is not required for the Department to accept the complaint.
- Signature
- Signature Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- If you want a copy of this report sent to you, please provide an email address.
- Email Address
Should be Empty:

District Police Citizen Complaint Form

SUBMISSION AND SIGNATURE