Form Center

2. NOTICE: It is a crime punishable as a Class "A" misdemeanor under section 240.45 of the New York State Penal Law to Knowingly make a false statement.

   1. Complete form below and click submit once finished - it will be automatically emailed to the Chief of Police
   2. Answer All questions
   3. Provide as much detail about your complaint as possible
5. Your Name (Last, First, Middle)*
7. Date of Birth*
   Date of Birth
8. Age*
10. Sex*

    1. Male
    2. Female
12. Address (number, street name, apartment number)*
14. City/Town*
15. State*
16. Zip Code*
18. Home Phone Number*
19. Work or Mobile Number*
21. When did you file this complaint?*
    When did you file this complaint?
22. Time of complaint*
    Time of complaint
24. Who is this complaint being made against (1) (Name, Rank, Number)*
26. Who is this complaint being made against (2) (Name, Rank, Number)
28. Where did this incident occur?*
30. Address or Location*
32. Location*

    1. Inside
    2. Outside
34. Your complaint is related to:
36. Was this an on-duty incident?*

    1. Yes
    2. No
37. Was this an off-duty incident?*

    1. Yes
    2. No
39. Was a traffic stop involved?*

    1. Yes
    2. No
40. Did you receive a traffic ticket?*

    1. Yes
    2. No
42. Were you arrested?*

    1. Yes
    2. No
44. What is the nature of your complaint?*
46. Are there any witnesses to this incident who should be interviewed?*

    1. Yes
    2. No
48. Witness Name
50. Address of Witness
52. Age
53. Phone Number
55. Witness Name (2)
57. Address of Witness (2)
59. Age (2)
60. Phone Number (2)
62. Explain the nature of your complaint in detail. *
Leave This Blank:


64. 1. Receive an email copy of this form.
65. Email address

    This field is not part of the form submission.

66. Submit

* indicates a required field