Police Department Citizen Complaint/Commendation Form

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Is This a Complaint or Commendation? *

Complaint

Commendation

Information about You

Name *

Phone Number

Email Address *

Date of Birth

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Street Address

City

State

Zip Code

Information about the Incident

Date

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Time

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Time AM

Time PM

Location

Information about Police Officer(s) or Employee(s) Involved

Name & Radio #

Information about Witnesses

Witness 1

Name

Phone

Address

Witness 2

Name

Phone

Address

Please Tell Us About the Incident *

By submitting this form, you attest to the truthfulness of the information on this form. Supplying false information to an agency is a Class C Felony under ORS.468.953.

Police Department Citizen Complaint/Commendation Form

Contact Information

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