Personnel Commendation/Complaint Form Form TypeCommendationComplaintContact InformationYour Full Name First Last Your Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Address Home/Cell PhoneWork PhoneEmail Address Incident InformationDate of Incident Date Format: MM slash DD slash YYYY Time of Incident : HH MM AM PM Location of IncidentName of Officer(s)Incident/Citation (Ticket) NumberDescription of Officer(s), if name not known:RaceSexAgeHeightWeightDressuniformplain clothesIdentifying CharacteristicsOfficer’s vehicle number or description (If name not known)Explain the circumstances, giving relevant facts known to you.* I do hereby affirm that the forgoing information provided by me is true and complete to the best of my knowledge and belief. I understand that any false misleading or untrue statements, accusations or allegations herein made by me, in relation to this complaint, either orally or in writing, to any person or persons investigating this complaint, may subject me to civil suit and/or criminal prosecution. I realize that it may become necessary in the investigation of this complaint for me to meet with a member or members of the Arlington County Police Department to discuss this complaint, either in the presence or absence of the accused officer(s), at the discretion of the Department. I accept the premise that if a Police Department disciplinary hearing or a Police Trial Board hearing results from my complaint, my testimony before such a hearing may be needed and I hereby agree to make myself available for such proceedings if requested to do so. NameThis field is for validation purposes and should be left unchanged.