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2. CCC #:
   For internal use only.
4. Filling Out the Form
   Whenever possible, the Citizen Compliment & Complaint Form should include as much information as possible, to include the identity of all persons involved in the alleged incident including the officer(s), witnesses; the specific behavior of the department employee and/or nature of the alleged misconduct; and the date, time and location that the incident occurred. Your concerns will be investigated, and you will be informed in writing of the outcome of the investigation.
6. Compliment or Complaint?*
   -- Select One --ComplimentComplaint
10. Name of Person Making the Report
11. Email Address
13. Phone Number
14. Address
16. City
17. State
18. Zip Code
22. Witness Name
23. Email Address
25. Phone Number
26. Address
28. City
29. State
30. Zip Code
34. Incident or Case No. (If known)
35. Date & Time of incident
    Date & Time of incident

    Date & Time of incident
36. Location of Incident
38. Officer(s) or Employee(s) Involved
42. Describe incident in detail, including additional witnesses, officer or employee name, etc.
44. Supporting Files
    Upload any documents, images, etc, that are relevant to your compliment or complaint. (Word, Excel, PDF, JPG, PNG)
45. Supporting Files
    Upload any documents, images, etc, that are relevant to your compliment or complaint. (Word, Excel, PDF, JPG, PNG)
49. Declaration
    I certify/declare under penalty of perjury under the laws of the State of Washington (R.C.W. Title 9A.72) that the foregoing statement is true and correct and that no threats, promises or inducements have been made to me regarding my statement. Regardless of any request for confidentiality under the Public Records Act, I understand that my identity may be disclosed if the case goes to trial, and that I may still be called to testify or to provide other evidence in this matter.
51. Identity Disclosure

    1. I do not want my identity disclosed upon public inquiries regarding this complaint without my permission.
53. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
55. Electronic Signature
56. Date
    Date
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

* indicates a required field