Columbus Division of Police Shield

Citizen Complaint Form

 

Complainant

Name: 

Sex:  / 

Age: 

Ethnic Group: 

Address: 

Phone Number: 

 

Occurrence

Location: 

Incident Number: 

Date: 

Time: 

Cruiser District: 

 

Personnel Involved (List additional involved personnel in the narrative below)

Name(s): 

Badge Number(s): 

 

Specific Details of Occurrence

 

 

Section 2921.15(B) of the Ohio Revised Code states that any person who knowingly files a false complaint of misconduct against a police officer is guilty of a misdemeanor of the first degree.

 

  You acknowledge, and understand the above Section 2921.15(B) of the Ohio Revised Code.

 

  You acknowledge that your above statements are true, and correct, to the best of your knowledge.