SAG HARBOR VILLAGE POLICE DEPARTMENT
70 DIVISION STREET, SAG HARBOR NY 11963
COMPLIMENT/COMPLAINT INFORMATION REPORT
Complete this form and submit it directly to Sag Harbor Village Police Headquarters, or fax it to (631) 725-5660
- Mail it to: Sag Harbor Village Police Department, PO Box 660 Sag Harbor, NY 11963
- Telephone the Department at 631-725-0247.
- E-mail Chief of the Department at: amcguire@sagharborny.gov
Check the appropriate category: Compliment Complaint CC #
(if applicable) _____________________________
Name: Last, First, M.I.
Date of Birth
Address Home Phone
E-Mail Address Cell Phone
Work Phone Permission to contact
Person Assisting (Interpreter, Representative) Relationship Contact Phone #
If Applicable: Witness Name: Last, First. M.I. Home Phone
Address Cell Phone
INCIDENT
Date of Incident Time of Incident Location of Incident
EMPLOYEE INFORMATION (if known)
Rank/Title Command Shield Name
M
F
Plainclothes Uniform On Foot In Car Marked Car Unmarked Patrol Car #: License Plate #:
Physical Description of Employee (eye color, hair color, approximate height and build, age, etc.)
DESCRIPTION OF INCIDENT (please include as much detail as possible)
Would you like a Police Department supervisor to contact you with regard to your comments? Yes No
Date: _____________________________ Signature: ___________________________________________________________
The Sag Harbor Village Police Department is committed to providing the highest quality police services to each and every member
of the community and your input is important to us. If you have a compliment or a complaint concerning an SHPD employee, please
do one of the following.
click to sign
signature
click to edit
![]()
