Dayton Police Department Complaint Form

Your Name*

First Last

Age*

Date of Birth*

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Cell Phone*

Work Phone

Best time to contact*

Morning
Afternoon
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What is your complaint?*

Location of incident*

Date of incident*

Officer(s) involved*

List any witness(es) to the incident*

Please include their name, age, phone number and address if known

Having been advised of the above law, I hereby affirm that he facts contained on this information form and my statement of allegation (s) against a Dayton Police Officer (s) is true and accurate. I certify that typing my name in the box below serves as my online signature.

Name

First Last

No person shall knowingly file a complaint against a peace officer that alleges that the peace officer engaged in misconduct in the performance of the officer's duties if the person knows that the allegation is false. Whoever violates this section is guilty of Making a False Allegation of Peace Officer Misconduct, a misdemeanor of the first degree.

Date