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Citizens Complaint Form

Home Village Departments Police Department Citizens Complaint Form

COMPLAINT INFORMATION:

NAME:*

DATE OF BIRTH:

HOME/CELL PHONE:*

LOCATION OF INCIDENT:*

INCIDENT DATE:*

TIME OF INCIDENT:

DATE COMPLAINT FILED:

NAME OF PERSON(S) COMPLAINING ABOUT:

PERSON 1:

PERSON 2:

PERSON 3:

PERSON 4:

WITNESSES WHO ACTUALLY SAW AND WERE PRESENT AT THE INCIDENT:

WITNESS 1 (Name, Address, Phone number):

WITNESS 2 (Name, Address, Phone number):

WITNESS 3 (Name, Address, Phone number):

WITNESS 4 (Name, Address, Phone number):

WITNESS 5 (Name, Address, Phone number):

PLEASE TYPE A SUMMARY OF COMPLAINING INCIDENT:

COMPLAINING SUMMARY:

PLEASE READ BEFORE SIGNING

IT IS THE POLICY OF THE LANSING POLICE DEPARTMENT TO THOROUGHLY INVESTIGATE ALL COMPLAINTS AGAINST EMPLOYEES OF THE DEPARTMENT. ILLINOIS LAW REQUIRES THAT ALL COMPLAINTS BE SUPPORTED BY SWORN AFFIDAVIT. AS SUCH, YOU WILL BE REQUIRED TO SIGN THIS COMPLAINT UNDER OATH OR AFFIRMATION. IF THE RESULTS OF THE INVESTIGATION REVEAL YOU KNOWINGLY PROVIDED FALSE INFORMATION REGARDING THIS COMPLAINT, YOU MAY BE SUBJECT TO CRIMINAL PROSECUTION.

AGREEMENT:*

BY CHECKING THIS BOX, THE ENTERED INFORMATION IS TRUE AND HONEST. IF THE RESULTS OF THE INVESTIGATION REVEAL YOU KNOWINGLY PROVIDED FALSE INFORMATION REGARDING THIS COMPLAINT, YOU MAY BE SUBJECT TO CRIMINAL PROSECUTION.

TYPE NAME TO REPRESENT SIGNATURE:*