Fillable Citizen Complaint Forms HELENA POLICE DEPARTMENT

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Citizen Complaint Forms HELENA POLICE DEPARTMENT

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The Citizen Complaint Forms HELENA POLICE DEPARTMENT form is 3 pages long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for City of Helena

BROWSE CITY OF HELENA (MT) FORMS

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HELENA POLICE DEPARTMENT
CITIZEN COMPLAINT FORM
Today’s Date:_____/_____/_____ Time: __________AM/PM
Location of incident: ________________________________________________
Nature of Complaint: _______________________________________________
This complaint concerns officer(s)_____________________________________
Date/Time of Incident: _____/_____/_____ ______ AM/PM
Case Number: ____________________________
Your personal information:
Name: __________________________________________________________
Home Address: ___________________________________________________
Business Address: _________________________________________________
Race___ Sex ___ Age___ Date of Birth ________________
Telephone (h)____________(w)____________(c)____________
Were you arrested?: Yes_____ No_____ If yes, Case #_______________
Is this a complaint regarding an officer’s use of force?: Yes ____ No ____ If yes:
What type of force was used?: _______________________
Were you injured?: Yes ____ No ____ If yes:
Type of injury:_______________________________
Location of injury (arm, leg, etc):_________________
Photos taken?: Yes_____ No_____
Parent/Guardian Name (if applicable): __________________________________
Telephone Numbers (h)________ (w)_______(c)_________
Witnesses to your complaint:
WITNESS NAME 1: _______________________________________________
Home Address: ___________________________________________________
Race__________ Sex _________Age_________ DOB:_____________
Telephone Numbers (h)___________ (w)____________(c)_____________
WITNESS NAME #2: _______________________________________________
Home Address: ___________________________________________________
Race__________ Sex _________Age_________ DOB: _____________
Telephone Numbers (h)____________ (w)_____________(c)___________
WITNESS NAME #3:_______________________________________________
Home Address: ___________________________________________________
Race__________ Sex _________Age_________ DOB: _____________
Telephone Numbers (h)____________ (w)____________(c)___________
____ of ____
Page
_______________________________________________
Summary of incident:
________________________________________________________________
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(continue on additional sheets as necessary)
I have read each page of this statement and certify that the facts contained herein are true and
correct. Knowingly giving false information to a Law Enforcement Officer is a punishable offense
under MCA 45-7-205.
Dated this ____ day of _______________ 20 _______________________________
__ ______.
Signature of person making statement
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Citizen Complaint Forms HELENA POLICE DEPARTMENT

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Completed 13 July 2020

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