Person(s) Who Actually Saw Event
Please Read Before Signing
I understand that it is a violation of the law to willfully
make a false report. in the event the report is shown to
be wilfully false, the information may be provided to the
State's Attorney for possible prosecution.
C.G.S. Sec. 53a157b
Signature
No action will be taken against anyone who, acting in good faith, makes a complaint whether or not the complaint is sustained. Also,
making a complaint will have no effect on any parking ticket or any matter before the Court, e.g. a pending traffic or criminal case.
Complete and send this form to:
Office of the Chief of Police
CCSU Police Department
1615 Stanley St.
New Britain, CT 06050
Once received, your complaint will be reviewed and assigned for investigation. An investigator will contact you if
additional information is needed. The Police Department will notify you in writing of the findings of the
investigation as well as any actions taken as a result.
Page 2 of 2
CCSU PD Form # 6 Revised
5/10/2010
Name Address Phone Number
Name
Name
Address
Address
Phone Number
Phone Number
Please explain what action you would like taken to resolve your complaint.
