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Complaint Concerning Police Practices
Case or Incident # (if known):
Date:
Your Name:
Cell Number:
(Last) (First) (Middle)
Home Number:
Email:
Address:
(Street) (City/Town) (State) (Zip code)
Complainant:
(Last) (First) (Middle)
Preferred Method of Contact:
Incident occurred on:
(Date) (Time) (Location)
Employee(s)/Officers(s) involved:
Name:
1.
2.
3.
4.
Witness(es) to Incident:
Name: Address:
1.
2.
3.
4.
Best Way to Locate Witness(es):
FOREST HEIGHTS POLICE DEPARTMENT
5508 ARAPAHOE DRIVE
FOREST HEIGHTS, MARYLAND 20745
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Please provide us with detailed information regarding this matter in your own words: (use extra
paper if necessary and attach to this form).
Complaining Party Signature Date
Witness Signature Date
Complaint Received By:
How? In Person
Phone
Other
Name/I.D. No./ Date
THIS SECTION ONLY APPLIES TO COMPLAINTS OF POLICE BRUTALITY
STATE
OF MARYLAND:
COUNTY OF
I hereby certify that on this day of , , before me, a DISTRICT
COMMISSIONARY/NOTARY PUBLIC of said state and county aforesaid, personally appeared
and made oath in due form of law that the matters and
facts as related above are true.
My commission expires:
District Commissioner/Notary Public Signature
Notary
SEAL/STAMP
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signature
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signature
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signature
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