Fillable Civilian Complaint English 081318 (County of San Bernardino Information Services Dept.)

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Civilian Complaint English 081318 (County of San Bernardino Information Services Dept.)

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BROWSE COUNTY OF SAN BERNARDINO INFORMATION SERVICES DEPT. (CA) FORMS

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655 EAST THIRD STREET, SAN BERNARDINO, CA 92415-0061 * PHONE (909) 387-3726 REV 06/18
SAN BERNARDINO COUNTY SHERIFF’S DEPARTMENT
CIVILIAN COMPLAINT
P#
DATE FILED
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 CIVILIANS’ COMPLAINTS. YOU HAVE A RIGHT TO A WRITTEN DESCRIPTION OF THIS
PROCEDURE. THIS AGENCY MAY FIND AFTER INVESTIGATION THAT THERE IS NOT ENOUGH
EVIDENCE TO WARRANT ACTION ON YOUR COMPLAINT; EVEN IF THAT IS THE CASE, YOU HAVE
THE RIGHT TO MAKE THE COMPLAINT AND HAVE IT INVESTIGATED IF YOU BELIEVE AN OFFICER
BEHAVED IMPROPERLY. CIVILIAN COMPLAINTS AND ANY REPORTS OR FINDINGS RELATING TO
COMPLAINTS MUST BE RETAINED BY THIS AGENCY FOR AT LEAST FIVE YEARS.
IT IS AGAINST THE LAW TO MAKE A COMPLAINT THAT YOU KNOW TO BE FALSE. IF YOU MAKE A
COMPLAINT AGAINST AN OFFICER KNOWING THAT IT IS FALSE, YOU CAN BE PROSECUTED ON A
MISDEMEANOR CHARGE.
I HAVE READ AND UNDERSTOOD THE ABOVE STATEMENT.
COMPLAINANT SIGNATURE
REPORTING PERSON
PHONE NO.
DOB
RESIDENCE ADDRESS (CITY, STATE, ZIP CODE)
BUSINESS ADDRESS (CITY, STATE, ZIP CODE)
PERSONS INVOLVED (IF OTHER THAN ABOVE)
NAME (LAST, FIRST, MIDDLE)
DOB
RESIDENCE ADDRESS (CITY, STATE, ZIP CODE)
BUSINESS ADDRESS (CITY, STATE, ZIP CODE)
DAY AND DATE OF INCIDENT
TIME OF INCIDENT
LOCATION OF INCIDENT
WITNESSES
NAME
ADDRESS
PHONE NO.
IF WITNESSES ARE NOT KNOWN, GIVE THEIR DESCRIPTION
NAME OR DESCRIPTION OF EMPLOYEE(S) INVOLVED
NAME
BADGE OR ID NO.
PHYSICAL DESCRIPTION
PERSON(S) ARRESTED
NAME
ADDRESS
PHONE NO.
RACIAL OR IDENTITY PROFILING PC 13519.4(e)
Do you believe you were stopped, arrested, searched, or detained by law enforcement based, at least in part, on your race or ethnicity
(including color), nationality/national origin, gender, age, religion, gender expression, sexual orientation, mental disability, or physical
disability? Yes No
If yes, what specific type of racial or identity profiling do you allege? (Check all that apply.)
Race or Ethnicity (Including Color)
Nationality/National Origin
Gender
Age
Religion
Gender Expression
Sexual Orientation
Mental Disability
Physical Disability
SIGNATURE OF REPORTING PERSON
SIGNATURE OF PARENT OR GUARDIAN (IF COMPLAINANT IS UNDER 18 YEARS)
DATE RECEIVED
PERSON RECEIVING COMPLAINT
EMPLOYEE ID NO.
BUSINESS TELEPHONE NO.
655 EAST THIRD STREET, SAN BERNARDINO, CA 92415-0061 * PHONE (909) 387-3726 REV 06/18
SAN BERNARDINO COUNTY SHERIFF’S DEPARTMENT
CIVILIAN COMPLAINT
P#
DATE FILED
SUMMARY OF COMPLAINT
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Civilian Complaint English 081318 (County of San Bernardino Information Services Dept.)

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Completed 29 August 2021

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