NEW ALBANY POLICE DEPARTMENT - New Albany, Ohio

Addendum C
Citizen Compliment/Complaint Form
Personnel Involved
Name: Unit#: Assignment:
Name: Unit#: Assignment:
Location
Place of Occurrence:
Type of Premises:
Date:
Time:
Person Making Compliment/Complaint
Name:
Phone#:
Address: Sex: Age:
Description of Incident (provide specific details/allegations)
Knowingly filing a complaint against a Police Officer that falsely alleges that the Officer engaged in misconduct in the performance of the Officer’s
duties is illegal and is punishable by a maximum of 6 months in jail and a $1000.00 fine. Ohio Revised Code §2921.15.
By signing below, I certify that the above report is true and correct to the best of my knowledge:
Signature (required)
Date
DO NOT WRITE BELOW THIS LINE - OFFICE USE ONLY
Received by:
Internal Control Number:
Date: Time: Referred to:
Complaint Withdrawn Complaint Sustained Complaint Resolved at Initial Contact Complaint Unfounded
Supervisor’s
Signature:
Date:
PD-99-121
Revised December 30, 2010