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2. Name:*
3. Date of Birth:
   Date of Birth:
5. Address*
7. City
8. State
9. Zip Code
11. Phone Number*
13. Email Address
15. Date and Time of Occurrence:
    Date and Time of Occurrence:

    Date and Time of Occurrence:
17. Location of Occurrence:
19. Officer(s) Involved:
20. Badge #:
22. Witness Name(s):
24. Witness Address
26. City
27. State
28. Zip Code
32. Please describe the circumstances regarding your complaint. (List additional witnesses, involved officers, and/or other relevant information that would help investigate your complaint):*

36. You have the right to make a complaint against a police officer for any improper police conduct. California law requires this agency to have a procedure to investigate citizens' complaints. You have the right to a written description of this procedure. This agency may find, after an investigation, that there may or may not be enough evidence to warrant action on your complaint. You have the right to know the disposition of your complaint. Misconduct complaints and any reports or findings relating to those complaints must be retained by this agency for at least five years. If the complaint is substantiated for criminal activity, the employee may be subject to criminal proceedings

40. I have read and understood the above statement. By typing my name below, I am submitting my signature.*
41. Signature of parent/guardian, if minor (under the age of 18):
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43. 1. Receive an email copy of this form.
44. Email address

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45. Submit

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