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Citizen Complaint Form
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Steps
1.
Step One
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2.
Incident Information
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Step One
Complainant's Information
Name
*
Age
*
-- Select One --
1-18
19-29
30-44
45-59
60+
Race
*
-- Select One --
Asian/Pacific Islander
Black/African American
Hispanic/Latino
Native American
White/Caucasian
Multi-Racial
Other
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Gender
*
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Male
Female
Address
*
City
*
State
*
Zip Code
*
Primary Phone
*
Alternate Phone
Alternate Phone
Best Time to Contact
*
Morning
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Best Day of Week
*
Sunday
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Tuesday
Wednesday
Thursday
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Incident Information
Date and Time
*
Date and Time
Date and Time
Location of Incident
*
Street address if known
Name(s) of employee(s)/officer(s) involved. If name(s) are not known, please provide a brief description.
Employee/Officer 1
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Employee/Officer 2
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No
Employee/Officer 3
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Employee/Officer 4
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Employee/Officer 5
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Employee/Officer 6
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Employee/Officer 7
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Employee/Officer 8
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Employee/Officer 9
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Employee/Officer 10
Name
Address
Phone
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Name
Address
Phone
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Name
Address
Phone
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Name
Address
Phone
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Name
Address
Phone
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No
Name
Address
Phone
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No
Name
Address
Phone
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No
Name
Address
Phone
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No
Name
Address
Phone
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Name
Address
Phone
Describe Complaint in Detail
*
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Supporting Information
After your submission, you will be contacted by a member of the Durham Police Department to gather supporting documents.
Acknowledgement
Complainant's Initials
*
My initials above acknowledge that the above information is true and correct to the best of my knowledge.
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