Fillable DES MOINES POLICE DEPARTMENT (City of Des Moines)

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DES MOINES POLICE DEPARTMENT (City of Des Moines)

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The DES MOINES POLICE DEPARTMENT (City of Des Moines) form is 2 pages long and contains:

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  • 4 check-boxes
  • 30 other fields

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File type: PDF

U.S.A. forms for City of Des Moines

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Citizen Complaint/Compliment Form 05/2020
DES MOINES POLICE DEPARTMENT
Citizen’s Complaint
Citizen’s Compliment
(DMPD Use Only)
Date Complaint Received
Complaint Registry Log Number
CITIZEN’S INFORMATION
Please provide your contact information but complaints and/or compliments may be made anonymously
Name:
Address:
City:
State:
Zip:
Day Phone:
Evening Phone:
INFORMATION ABOUT INCIDENT
Date of Contact/Incident:
Location of Contact/Incident:
Police Case Number (If Applicable):
WITNESS(ES) INFORMATION
Name:
Contact #
Name:
Contact #
Name:
Contact #
EMPLOYEE(S) INFORMATION
Name:
ID #
Name:
ID #
Name:
ID #
Citizen Complaint/Compliment Form 05/2020
DETAILS ABOUT THE INCIDENT OR ACTION
(May Attached Additional Pages if Needed)
RECOMMENDATIONS
(What Would You Like To See Happen)
FOLLOW UP & DECLARATION
Would you like to be contacted by the employee(s) supervisor? Yes No
“I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing
is true and correct.” (RCW 9A.72.085)
Signature of person completing form: _________________________________________________
Completed forms may be delivered or mailed to:
Des Moines Police Department
21900 11 Avenue South
Des Moines, WA 98198
Attention: Professional Standards Sergeant
Receiving Supervisor:
Employee(s) Supervisor:
Date Received:
(DMPD Use Only)
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DES MOINES POLICE DEPARTMENT (City of Des Moines)

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Completed 3 August 2020

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