Form Center

2. Citizen / Neighborhood Issue & Complaint Form
4. Filing Instructions
   This form asks you to identify yourself and then to provide specific details about your complaint. Your complaint will then be investigated. During the course of the investigation, you may be contacted to clarify the details of your complaint or to provide additional facts regarding the basis of your complaint.
6. Nature of Complaint
8. Name of Complainant
9. Home Address
11. City / State / Zip Code
12. Business Phone #
13. Cell Phone #
15. Other Complaints and/or Witnesses (if applicable)
17. Incident Location
18. Date & Time
    Date & Time

    Date & Time
20. Vehicle (if involved)
21. Vehicle Indentification #
23. Summary of Complaint
25. Terms & Conditions
    I understand that this Statement of Complaint will be reviewed by a sergeant of the Richton Park Police Department and may be the basis for an investigation. Furthermore, I sincerely and truly declare and affirm that the facts contained herein are complete, accurate, and true to the best of my knowledge and belief. I further declare and affirm that my statement has been made by me voluntarily without persuasion, coercion, or promise of any kind. Additionally, I understand, and it is my desire, that this complaint will be investigated diligently. I further understand that if the investigation proves these allegations to be false, I may be liable to both criminal and civil prosecution. I also understand that in some cases I may be asked to submit to a polygraph examination as part of the investigation. Lastly, I understand that, under the Rules and Regulations of the Board of Fire & Police Commissioners a full-time police officer against whom a complaint is filed may request a Hearing before such Commission. By signing and filing this complaint, I hereby agree to appear before said Commission, if one is requested by the officer, and to testify under oath concerning all matters relevant to this complaint.
27. Electronic Signature of Complainant*

    1. Electronically Signed
28. Date
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field