Form Center

2. 
3. Citizen Comment & Complaint Form
5. Complainant's Contact Information
7. First Name*
8. Last Name*
9. Date of Birth*
   Date of Birth
11. Home Address*
13. City*
14. State*
15. Zip*
17. Primary Contact Number (Home/Cell)*
18. Secondary Contact Number (Home/Work)
22. Complaint Made Against (Deputy/Employee Name)*
24. Location of Contact*
25. Date of Contact*
    Date of Contact
27. Summary of Complaint/Allegations*
31. Is a Witness Available?*

    1. Yes
    2. No
32. Is the Witness willing to corroborate?*

    1. Yes
    2. No
33. How Many Witnesses are there?
    -- Select One --123+
35. First Witness Name
36. First Witness Contact Number
38. First Witness Home Address
40. City
41. State
42. Zip
44. Second Witness Name
45. Second Witness Contact Number
47. Second Witness Home Address
49. City
50. State
51. Zip
53. Multiple Witness Entry
    Enter in each witnesses Name, Contact Number, and Home Address on a new line
57. Review & Submission
    I have reviewed all information within this complaint and certify that the facts in this complaint are true and correct. By adding my electronic signature below, I accept that this will be the same as signing my name to a legal document.
59. Compainant's Electronic Signature*
60. Date Signed*
    Date Signed
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field