TOWNSHIP OF LONG HILL
POLICE DEPARTMENT
PROFESSIONAL STANDARD COMPLAINT REPORT
CAD #
UCR# PSU # PROSECUTOR’S #
COMPLAINANT
NAME (YOU CAN REMAIN ANONYMOUS)
ALIAS
ADDRESS
CITY
STATE ZIP PHONE
SSN
AGE SEX RACE
EMPLOYER/SCHOOL
PHONE
ADDRESS
CITY STATE ZIP
INCIDENT
PROCEDURAL USE OF FORCE DEMEANOR OTHER:
COMPLAINT AGAINST
OFFICER’S NAME
BADGE #
OFFICER’S NAME
BADGE #
DATE/TIME OCCURRED
LOCATION SECTION
DATE/TIME REPORTED
LOCATION
DETAILS (GIVE DESCRIPTION OF ANY INJURIES, TREATMENT LOCATION, DATE, AND DOCTOR IF APPLICABLE.)
FALSE POLICE REPORTS TO LAW ENFORCEMENT AGENCY
Anyone who makes a fictitious report to a law enforcement agency of an offense or incident knowing it did not occur, is a
disorderly person and can be charged under 2C:28-4bl of the New Jersey Criminal Justice Code.
NAME/SIGNATURE OF COMPLAINANT
DATE
REPORT RECEIVED BY:
DATE/TIME
PROFESSIONAL STANDARDS USE
FORWARDED TO:
DATE/TIME
PROFESSIONAL STANDARDS OFFICER SIGNATURE
BADGE DATE
Please print and sign the completed form. Mail the completed form to:
Long Hill Township Police Department
Attn: Chief of Police
264 Mercer Street
Stirling, NJ 07980
Print Form