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Complaint Intake Form

  1. Complainant Information:

  2. Complaint:

  3. Witness Information:

  4. Member Information:

  5. Was the Member in Uniform at the time of the incident?

  6. Was the Member in a marked or unmarked car:

  7. Was the Member in Uniform at the time of the incident?

  8. Was the Member in a marked or unmarked car:

  9. F.S.S. 837.06 Whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor of the second degree, punishable as provide in §775.082 or §775.083

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  11. This field is not part of the form submission.