Legal Redress Form

Name of Person Filing Complaint

Address (Include City, State, and ZIP)

Email

Telephone (Home)

Telephone (Cell - Optional)

Telephone (Work - Optional)

Entity

(Person, Organization, or Company) about whom you are complaining (note: If it is a law enforcement officer, include City or County, and Badge No./Car No. )

Date and Time of Incident

(if there is more than one occurrence, please use additional space provided)

Location of Incident

Please check the statement(s) that are related to your incident.

The offender(s) did not conduct themselves in a professional manner (resulting in the violation of civil right(s)).The offender(s) communicated bias based upon race, gender, national origin, religion, sexual orientation or disability.

Please explain in your own words the particular description of the acts and conduct of offender(s) which gives rise to your complaint.

Witnesses to this Incident (Important)