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2. Contact Information
   Anonymous complaints will not be sufficient to sustain the Department's complaint process. Please provide contact information so that we may follow-up with you.
4. First Name*
5. Last Name*
7. Date of Birth
   DD/MM/YY
9. Address1
11. Address2
13. City
14. State
15. Zip
17. Phone Number*
19. Incident Information
    Please provide as many details as possible regarding the circumstances of your complaint.
21. Type of Complaint
    -- Select One --False ArrestFalse ImprisonmentUnlawful seizure of propertyTrespassExcessive or unlawful forceDiscrimination on the basis of race, nationality, creed, sex age, or statusUse of authority for private endsHarassmentFailure to perform the duties of a police officerFailure of an officer to properly identify him/herself as a police officerViolations of law, ordinance and/or work rulesOther/Unknown
23. Date and Time of Incident
    Date and Time of Incident

    Date and Time of Incident
24. Case #
26. Location
28. Officer Name (s)
30. Witnesses
32. Statement of Facts*
34. Disclaimer
    The department is required by Wisconsin State Statute [66.0511(3)] to inform you that, "whoever knowingly makes a false complaint regarding the conduct of a law enforcement officer is subject to a class A forefeiture" Wisconsin State Statute [946.66(2)].
36. Certification*

    "I hereby certify that to the best of my knowledge, and under penalty of perjury, that the statements made herein are true."

    1. Yes
38. Complainant's Signature*
    Type your name in this field to serve as your signature and understanding of the above disclaimer and certification.
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40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

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