Forms • Emeryville • CivicEngage

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Citizen Complaint Form

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Name:

Address:

City:

Zip:

Phone:

Complaint Type:

Incident/Time

Incident Location

Police Case Number:

Involved Employee:

Witnesses:

Details of Incident (Provide as much information as possible): *

Date:

To my knowledge everything in the above fields is true. (Please initial box below.)

* indicates required fields.