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First Name
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Last Name
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Phone
Email Address
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Address
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City
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State/Province
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Postal Code
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Name of Officer or Badge Number
STATEMENT OF COMPLAINT
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Please provide as much detail as possible. Be sure to include date(s) of the incident(s), specific location(s), and any supporting details. Describe the specific way(s) in which you believe you have been affected.
LEGAL AND SIGNATURE
I hereby certify that the statements given by me herein are true and accurate to the best of my personal knowledge. I understand that making untrue declarations to public servants or untrue statements under oath of affirmation are punishable by law. If I do not cooperate fully with the complaint process, my complaint will be closed with no further action.
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Complainant Signature
By clicking "Submit" using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document is as valid as if you signed the document in writing.
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