Fillable -NEW- Routine Complaint Form ( Non- Emergency Incidents) (Town of Brookfield)

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-NEW- Routine Complaint Form ( Non- Emergency Incidents) (Town of Brookfield)

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The -NEW- Routine Complaint Form ( Non- Emergency Incidents) (Town of Brookfield) form is 2 pages long and contains:

  • 0 signatures
  • 14 check-boxes
  • 104 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Brookfield

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Page 1 of 2
BROOKFIELD POLICE DEPARTMENT
63 Silvermine Road • Brookfield, CT 06804
(203) 775-2575 • Fax: (203) 740-3442
FOR EMERGENCIES DIAL 911
Call# ____________ Case# _______________
Date Received: ____________
Assigned Oficer: _______________________________________
(Department Use Only)
Routine Complaint Report
(non-emergency incidents only)
INCIDENT INFORMATION
TYPE OF CRIME (CHECK ONE):
THEFT (UNDER $1000)
CAR BREAK-IN
HARASSMENT
FORGERY
DESTRUCTION OF PROPERTY
VANDALISM/GRAFFITTI
DAMAGED PROPERTY
FRAUD/IDENTITY THEFT
INFORMATION/TIPS
LANDORD/TENANT
LOST/FOUND PROPERTY
NEIGHBOR TROUBLE
STOLEN BICYCLE
STOLEN LICENSE PLATE
THEFT FROM MOTOR VEHICLE
BAD CHECKS
THEFT (OVER $1000)
ANIMAL PROBLEMS
PARKING COMPLAINTS
LATE REPORTED MOTOR VEHICLE ACCIDENTS
CRIME/INCIDENT OCCURRED ON/BETWEEN THE FOLLOWING DATES AND TIMES
DATE:
TIME:
DATE:
EXACT ADDRESS OF INCIDENT:
BUSINESS/PLACE NAME:
COMPLAINANT/ REPORTING PARTY
(COMPLETE ALL FIELDS)
NAME (LAST,FIRST,MIDDLE INITIAL):
ADDRESS:
CITY:
STATE:
ZIP:
CELL PHONE:
OTHER PHONE:
EMAIL:
DATE OF BIRTH:
DRIVER’S LICENSE STATE AND NUMBER:
OTHER PERSON INFORMATION (IF APPLICABLE)
SELECT ONE:
SUSPECT
WITNESS
OTHER
NAME (LAST,FIRST,MIDDLE INITIAL):
ADDRESS:
CITY:
STATE:
ZIP:
CELL PHONE:
OTHER PHONE:
EMAIL:
DATE OF BIRTH:
DRIVER’S LICENSE STATE AND NUMBER:
GENDER:
RACE:
ETHNICTY:
HEIGHT:
WEIGHT:
EYE COLOR:
HAIR COLOR:
CLOTHING DESCRIPTION:
VEHICLE INFORMATION (IF APPLICABLE)
VEHICLE # 1 BELONGS TO:
COMPLAINANT/VICTIM
SUSPECT
YEAR:
MAKE:
MODEL:
COLOR:
BODY STYLE
LICENSE PLATE #
STATE:
VIN:
DAMAGE AMOUNT:$
VEHICLE # 2 BELONGS TO:
COMPLAINANT/VICTIM
SUSPECT
YEAR:
MAKE:
MODEL:
COLOR:
BODY STYLE
LICENSE PLATE #
STATE:
VIN:
DAMAGE AMOUNT:$
PROPERTY INFORMATION (IF APPLICABLE)
ITEM # 1 WAS:
STOLEN DAMAGED
# OF ITEMS:
VALUE:$
MAKE:
MODEL:
COLOR:
SERIAL #:
DESCRIPTION:
ITEM # 2 WAS:
STOLEN
DAMAGED
# OF ITEMS:
VALUE:$
MAKE:
MODEL:
COLOR:
SERIAL #:
DESCRIPTION:
ITEM # 3 WAS:
STOLEN
DAMAGED
# OF ITEMS:
VALUE:$
MAKE:
MODEL:
COLOR:
SERIAL #:
DESCRIPTION:
OTHER PERSON
OTHER PERSON
LOST/FOUND
LOST/FOUND
LOST/FOUND
03/24/20
Page 2 of 2
NARRATIVE
IN AS MUCH DETAIL AS POSSIBLE, DESCRIBE THE CRIME/INCIDENT THAT OCCURRED (WHO, WHAT, WHEN, WHERE, WHY, HOW):
FOR MOTOR VEHICLE INCLUDE ALL INVOLVED VEHICLES, LOCATION, DIRECTION OF TRAVEL, AND ACTIONS LEADING TO THE CRASH:
This is an official Town of Brookfield Police Department document, which will become the official police report for this
incident. If you have insurance coverage, this form will assist you in filing a claim. Please note that you must include
your FULL NAME and DATE OF BIRTH (as well as all other required fields) for the report to be officially filed.
INSTRUCTIONS FOR USE: After fully completing the information required on this form, save a copy to your computer.
Call the Brookfield Police Department routine telephone 203-775-2575 to report a Routine Incident. The Dispatcher
will take your name, address, and phone number. An Officer will call you within one hour to discuss your complaint.
You will email your completed form to the officer after your discussion.
PLEASE "E-SIGN" AND EMAIL FORM TO ASSIGNED OFFICER UPON REQUEST
Be advised; Connecticut General Statute states that falsely reporting an incident in the first degree is a class D felony (53a-180).
Name:______________________
Date:________________________
(
By typing your name above for this official Town of Brookfield Police Department document, you acknowledge
that
this report is true to the best of your knowledge and is not made to mislead a law enforcement officer in the
performance of his/her duty or function.)
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-NEW- Routine Complaint Form ( Non- Emergency Incidents) (Town of Brookfield)

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Completed 14 July 2020

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