2. If this is an emergency or a crime in progress, do not use this form; instead call 911 immediately.
4. I Certify the Following: *

   1. This is NOT an emergency or a crime in progress; I understand that I may not receive a police response for as long as 3 business days.
6. Last Name*
7. First Name*
8. Date of Birth*
9. Today's Date*
11. Home Address*
12. Phone*
13. Email*
15. Exact Address of Incident
16. Date of Incident
17. Time of Incident
19. Narrative
    Please state your concern, including names, times, locations, witnesses, and any other information or details that would be helpful in the investigation of the event.
21. It is against the law to make a complaint that you know to be false. You are notified that statements you make in this document may be presented to a magistrate or a judge in lieu of your sworn testimony at a preliminary examination. Any false statement you make and that you do not believe to be true may subject you to criminal punishment as a class A misdemeanor.
23. Electronic Signature*

    1. By checking this box, I certify that I have read and understand the above statement and further certify that the representations made by me in this document are true and correct.
25. Within 3 business days of submitting this form, you should receive a confirmation of receipt via email.
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27. Submit

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