Initial Complaint Form

Current Complaint Details
Complete

Initial Complaint Form

Complainant’s Name:

First

Middle

Last

Complainant’s Residential Address:

Address/Street

City/Town

State/Province

ZIP/Postal Code

Complainant’s contact information:

Phone Number

Email Id

Witness(s) (including address and phone if available):

Date and time of incident:

Location of incident:

Person against whom complaint is made (if name is unknown give physical description and or badge/vehicle number):

Briefly describe your complaint:

Note:

Information you provide is subject to the Minnesota Government Data Practices Act. This law classifies certain information as available to the public on request.

Minnesota State Statute 609.505, Subd. 2 states that whoever informs, or causes information to be communicated to, a peace officer, whose responsibilities include investigating or reporting police misconduct, that a peace officer has committed an act of police misconduct, knowing that the information is false, is guilty of a crime.

After reading the paragraph above I hereby declare that the above and/or attached statements are
correct and true.

Signature

Sign above

Date of Signature