Comment on a Police Officer or other Police Department Employee

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Date of Incident:

Location:

Officer/employee's Name:

Badge No.:

Describe What Happened:

Additional Information (Optional):

Your Name:

Street Address:

City:

State:

Zip:

Phone Number:

Enter a valid phone number. Example: 123-456-7890

E-Mail Address:

Enter a valid email address. Example: name@company.com

Would you like us to contact you regarding this incident?

Yes

If yes, preferred contact method:

Phone

E-mail

Additional Comments:

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