Internal-Affairs-Complaint-Form

East Point Police Department Complaint Allegation Supplemental Form
IA Complaint#
Assigned to:

IACIDFODSSD
Date

MonthDayYear
Date
Complainant’s Name
Date

MonthDayYear
Date
Complainant’s Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
E-Mail Address
example@example.com
Allegation is against:

Police OfficerCivilian EmployeeOther
Type of Complaint - Indicate by checking the appropriate box(es)

CourtesyUse of Force (Physical)Use of Force WeaponOn-Duty MisconductOff-Duty MisconductSOP ViolationLaw ViolationOther
Date, Day and Time of Incident?

MonthDayYear
Date
Hour MinutesAM/PM Option
Incident Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Case Number if Known
Witness Information:
Witness Information:
Additional Witnesses?

YesNo
Witness Information:
Witness Information:
Please give statement:
Once you have completed this form, you may telephone the Police Administration Office, (404)559-6218 or 404-559-6219 and request to speak with the Internal Affairs Unit.
I understand that by signing this form, I am stating that these are the facts to the best of my knowledge. I also understand that if I make a false statement to an officer, criminal actions may be levied against me.
Complainant’s Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

East Point Police Department Complaint Allegation Supplemental Form