JPD Citizen Complaint Form

2. Date:
   Date:

3. Internal Affairs Case Number:

5. Complainant's First Name

6. Complainant's Last Name

8. Address1

10. Address2

12. City

13. State

14. Zip

16. Home Phone Number

17. Work Phone Number

18. Cell Number

20. Type of Allegation:

22. Location of Occurrence:

24. Date of Occurrence:
    Date of Occurrence:

25. Time of Occurrence:

26. A.M. or P.M.:
    -- Select One --A.M.P.M.

28. Employee(s) Allegedly Involved:

30. Witness:

32. Name:

33. Address:

34. Phone:

36. Name:

37. Address:

38. Phone:

40. Name:

41. Address:

42. Phone:

44. Description of Allegation / Statement of Complaint:

48. COMPLAINT AFFIRMATION:

50. I, (Complainant's Name)

51. do hereby affirm that the foregoing information is true and complete to the best of my knowledge and belief. I understand that any false, misleading, or untrue statements or writing to any person(s) investigating this complaint, may subject me to civil prosecution by the accused. I further realize that it may become necessary, during the investigation of this complaint, for me to meet with a member(s) of the Jonesboro Police Department to discuss this complaint; either in the presence or absence of the accused department member(s) at the discretion of the department. I hereby accept the premise that if any action is initiated through a court or administrative hearing as a result of my complaint, my testimony before these hearing may be required. I hereby agree to make myself available to aforementioned court or administrative hearing when requested to do so.

53. Complainant's Name:

57. Related Incident Report Case # (attach copy):

59. Receiving Officer’s Signature:

61. Reviewed by:

62. Rank:

Leave This Blank:


63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit

* indicates a required field