Citizen Complaint Form LAST NAMEFIRST NAMEMIDDLE INITIALSTREET ADDRESSCITYSTATEZIPPHONEDATE OF BIRTH EMPLOYEREMPLOYER PHONEEMPLOYEE NAME(Required)Against Whom is the Complaint?EMPLOYEE RANKEMPLOYEE RADIO NUMBERDATE OF COMPLAINT(Required) Today’s DateTIME OF COMPLAINTCurrent TimeINCIDENT DATE(Required) On what Date did the Incident occur?INCIDENT TIMEAt what Time did the Incident occur?COMPLAINT(Required)Please describe, in detail, the incident in concern.ADDITIONAL COMPLAINT INFORMATIONADDITIONAL COMPLAINT INFORMATION (2)PRINTED NAME(Required)Please type your name, or “Anonymous”, to affirm that everything stated above is true.