HomeMy Public PortalAboutWPD Complaint Form (Public)a
POLICE
(ylII Illilli2
4TE R-1
WATERTOWN POLICE DEPARTMENT
Report of Alleged Police Misconduct
Date:
Complaint Number:
Incident Number (If applicable):
Complainant Information
Name:
Phone:
Date of Birth:
Address:
No.
Street City/Town Zip
Social Sec #
Witness Information
1. Name:
Phone:
Date of Birth:
Address:
No.
Street City/Town Zip
Social Sec #
2. Name:
Phone:
Date of Birth:
Address:
No.
Street City/Town Zip
Social Sec #
Complaint Received by
Name Rank
Manner in which complaint was received: ❑ In Person ❑ Phone
❑ Letter ❑ Other, explain:
Alleged Incident Information
Date:
Time:
Location:
Accused Officer (if known):
Narrative (Please include as much information as possible)
-------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------
Signature of Complainant:
Date:
WPD Form Number 02-C-01 (TAD #1) Page 1