2. Citizen Information: First Name*
3. Last Name*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
12. Email Address*
14. Date and Time of Incident*
    Date and Time of Incident

    Date and Time of Incident
15. Location of Incident*
17. Briefly state the nature of the complaint, supplying the names, addresses and telephone numbers of other persons who have direct knowledge supporting this complaint. *
19. Signature of Complainant*
    NOTICE: Whoever knowingly makes a false complaint regarding the conduct of a Law Enforcement Officer is subject to a Class A forfeiture under Wisconsin Statute 946.66.
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

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