Police Complaint — Parkside Police Department

Parkside Police Complaint Form

If you wish to fill out a paper complaint form, please contact the Parkside Police Department.

SECTION #1: Name of Person Making Complaint

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Age

Date of Birth

YYYY

SECTION #2: Alleged Victim Information Below

Is alleged victim same as complainant?

Yes (Skip to Section #3)

No (Fill out victim information)

Victim Full Name

First Name

Last Name

Victim Email (If known)

Victim Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Victim Phone Number

(###)

###

####

SECTION #3: Witnesses That Have Direct Knowledge Of This Incident

Is the complainant a witness?

Yes (Skip to section #4)

No (Fill out witness info below)

No Witnesses (skip to section #4)

Witness Full Name

First Name

Last Name

Witness Email

Witness Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Witness Phone Number

(###)

###

####

Additional witnesses or notes, enter the information below

SECTION #4: Incident In Question

Date of Incident

YYYY

Time of Incident

Hour

Minute

Second

Location of Incident

Name of Officer Involved

First Name

Last Name

Addition Officer Details

Detailed Description of Incident

I hereby confirm that the above information is true and correct.

Sign

Type your name here

ANY FALSE STATEMENTS MADE MAY BE SUBJECT TO PROSECUTION UNDER PERJURY, FALSE REPORT OR CIVIL STATUTES. UNDER PENALTY OF PERJURY THE COMPLAINANT SWEARS THAT THE FACTS CONTAINED ON THIS FORM ARE WITHIN THEIR PERSONAL KNOWLEDGE AND ARE TRUE AND CORRECT

Parkside Police Complaint Form

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