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Public Complaint Form
Section I. About You
Name
First Name
Middle Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Home Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Work Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Cell Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Method of Contact
Home Phone
Work Phone
Cell Phone
Email
Preferred hours for call
Section II. About Known Witnesses
Tell us about others who may have witnessed or taken part in the incident. If extra space is needed, list the additional witnesses or information in Section V.
*
Section III. About Our Employees
List all Van Buren County Sheriff's Office employees you are complaining about, and include rank and full name if known. If extra space is needed, list the additional employees or information in Section V.
Section IV. About the Incident
Date & Time
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Location
Related Police Report Number
If none enter N/A or enter unknown if not known
Sheriff's Office License Plate Number
If none enter N/A or enter unknown if not known
Section V. Description of Incident
To assist us with accurately identifying the incident, describe the incident in as much detail as possible. Use this area to list any additional individuals having knowledge of the incident who were not already disclosed. Attach additional sheets as necessary.
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