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2. Nature of Incident
3. Date and Time Received
   Date and Time Received

   Date and Time Received
5. Complaint Against
6. Division
8. Complainant Contact Information
10. First Name*
11. Last Name*
12. Phone Number*
14. Address*
16. Address 2
18. City*
19. State*
20. Zip Code*
22. Witness Information
24. Name
26. Address
28. City
29. State
30. Zip Code
32. Please Specify reason of Commendation or Complaint*
34. Location of Incident
35. Date and Time
    Date and Time

    Date and Time
37. ***Please read before signing*** A person is guilty of a second degree misdemeanor if he/she makes a false written statement (F.S.S. 837.06). Also, a person is a person is guilty of a first degree misdemeanor if he/she knowingly gives false information to a law enforcement officer (F.S.S. 837.05). I certify that the information contained in this complaint is true and correct to the best of my knowledge.
39. Signature of Complainant*
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41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field