Forms • Emeryville • CivicEngage

Skip to Main Content

Website Sign In

Citizen Complaint Form

Leave This Blank:

Name:

Address:

City:

Zip:

Phone:

Email Address:

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.