PUBLIC COMPLAINT FORM

Description of complaint continued
Officer Name
Badge #
Officer Name
Badge #
Officer Name
Badge #
Name
Badge #
Discription of Officers if names unknown
Witness 1: Name
Phone
Address
Witness 2: Name
Phone
Address
Witness 3: Name
Phone
Address
Photographs or other Evidence

Cancelof
Completed by officer receiving complaint:
Name
RankBadge
Location
Complaint received by:

LetterIn PersonFaxEmail
Photos taken by police? If yes, please complete date, time and officer & badge #

YesNo
Date

MonthDayYear
Date
Time
Name and Badge #

Type a question

Consent to release medical informationCopy of completed complaint provided to complainantPreliminary complaint classification by chief
Informal resolution discussed?
If yes, attach. If no, explain below.
Person information on this form is collected and disclosed under the authority of the Police Services Act (s.57 and/or 58) and will be used for the purpose of investigating the complaint herein.

Questions?

Oak Park Police Department

3857 Harrington Street

Lyons GA 30436

912-578-3003
Should be Empty: