Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Preferred method of contact *

Phone

Email

Which APD Employee is this concerning? *

If the Officer or Employee's name is unknown, please provide any known identifying information (e.g., physical description, badge number, vehicle description, vehicle number).

Chief Scott Young, #9200 Sergeant Andrew Worrall, #9180 Services Supervisor Megan Young Officer Jason Ozenberger, #9187 Officer Rick Smith, #9195 Officer Jeff Barringer #9199 Officer Troy Paris, #9201 Officer Jeff Voss, #9202 Officer Todd Henderson, #9161 Officer Doug O'Brien, #9182 Officer Allie Leiva, #9183 Officer Tracey Cleeton, #9198 Unknown (Please fill out the description box below)

Unknown Officer or Employee Description

Please only use this box to describe an unknown Officer or Employee.

Date of incident *

MM

DD

YYYY

Location of Incident *

Case Number (if applicable)

Please describe the incident giving rise to your complaint in as much detail as possible. *

Witnesses

Please provide information about any witnesses to the events giving rise to your complaint.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

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Email

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email

To ensure public trust and confidence in the Department, every complaint will be thoroughly investigated. If any further information is needed to process a complaint, you and any witness(es) may be contacted by the Supervisor conducting the investigation. Following the conclusion of the investigation, you will be notified in person, by mail or by telephone by the Supervisor of the conclusion reached in the investigation of your complaint.

Please type out your FULL LEGAL NAME in the space provided below. Be aware that doing so will serve as your formal signature. By signing in this manner, you affirm that the information contained within your complaint is both accurate and truthful to the best of your knowledge. *