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INTERNAL AFFAIRS REPORT FORM
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
DOB
-
Month
-
Day
Year
Date
Officer(s) Subject to Allegation
Provide whatever info is known.
Officer(s)
Badge No.
Incident Site
Date
-
Month
-
Day
Year
Date
Time
In the space below, describe the type of incident (traffic stop, street encounter) and any information about thealleged conduct. If you cannot fit your response below, feel free to use extra pages and attach them to thisdocument. If you do not know the officer’s name or badge number, provide any other identifying information.
Other Information
How was this reported?
In Person
Phone
Letter
Email
Other
Any physical evidence submitted?
Yes
No
If yes, describe using the space below
Was incident previously reported?
Yes
No
If yes, describe using the space below
Submit
Should be Empty: