7/2020 PD-401
Everett Police Department Citizen Appreciation Form
Nam
e
Pho
ne Number
Address
Witness Name Phone Number
Witness Address
Date and Time of Incident Location of Incident Incident or Event No. (If known)
Employee Involved Additional Employee Involved
Describe the incident.
“THANK YOU FOR SUPPORTING YOUR EVERETT POLICE DEPARTMENT”
Signature Date Witness Signature Date
Accepted By: Pers. No. Date
Route to Alicia Hammond
Submit Via Email