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2. Police Accountability Board Complaint Form
4. Complaints received by the Police Accountability Board will be forwarded to the appropriate law enforcement agency within three business days of receipt of the complaint. Complainant should expect to be contacted by a representative of the law enforcement agency regarding the complaint process moving forward.

6. Your Contact Information:

8. Last Name*
9. First Name*
10. Middle Name
12. Address*
14. City*
15. State*
16. Zip Code*
18. Phone Number*
19. Email Address*
23. Law Enforcement Officer's Name(s):
25. Last*
26. First*
28. Last
29. First
31. Last
32. First
34. Additional names shall be placed in the description section below.
36. Name of Law Enforcement Agency:*
40. Please provide a description of the events as you allege they occurred. In your description, please include the date, time, and location of when and where the events occurred.
42. Date:
43. Your Signature (Type your name here):
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field