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Commendation / Complaint Form
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Page 1
Instructions:
Please carefully read and complete all applicable blocks on form.
Report Type
Commendation
Complaint
Reporting Person First Name, Middle Initial, and Last Name
Address
City
State
Zip Code
Home Phone Number
Work Phone Number
Email Address
*
Gender - Optional
Race - Optional
Age - Optional
Officer(s) Involved
Officer’s Name
Badge Number
Officer’s Name
Badge Number
Officer’s Name
Badge Number
Officer’s Name
Badge Number
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Page 2
Witness Information
First Name, Middle Initial, and Last Name
Age - Optional
Address
City
State
Zip Code
Home Phone Number
Work Phone Number
Gender - Optional
Race - Optional
First Name, Middle Initial, and Last Name
Age - Optional
Address
City
State
Zip Code
Home Phone Number
Work Phone Number
Gender - Optional
Race - Optional
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Page 3
Incident Description
Incident Date & Time
Incident Date & Time
Incident Date & Time
NHPD Incident Number (If Known)
Incident Location / Address
City
State
Zip Code
Summary of Commendation or Complaint
You May Attach Any Pertinent Documentation
Affirmation
While supporting the reporting of legitimate complaints as a means by which the department can be accountable to the public, the department also seeks to hold members of the public responsible for the reporting of false and malicious allegations. The Nags Head Police Department will initiate appropriate legal action in cases involving false reporting.
It is a criminal offense to knowingly make a false report to law enforcement agencies or officers.
(North Carolina General Statute § 14-225)
Agreement
*
I have read and understand the above statement.
Reporting Person eSignature
You agree and acknowledge that 1) your form 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.
Date
Date
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