Employee Misconduct Allegation (PD-92e)

Employee Misconduct Allegation

City of Bethlehem Police Department
Form Version
Use this electronic form for submitting a complaint against a City of Bethlehem police officer.

If you do not know the answer to a question or prefer not to answer, leave blank.

You must sign or mark the final page for the complaint to be submitted.
Form PD-92e (08-2022)

Complainant Information
Even if you are filing a complaint on behalf of someone else, please include your information on this page. This information is optional, but can greatly assist us.
I am filing this on behalf of someone else.
Name of Person You Represent, if Known
Your Information
Name

First NameLast Name
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Work/Cell Phone Number
Email
Date of Birth

MonthDayYear
Date
Sex
Race/Ethnicity

Verification
The facts set forth herein are true to the best of my knowledge, information, and belief. This verification is subject to the penalties of 18 Pa.C.S. § 4904 (relating to Unsworn Falisification to Authorities).
Signature or Mark*

Clear
Date/Time

MonthDayYear
Date
Hour Minutes
Please verify that you are human*
Should be Empty:

Employee Misconduct Allegation