Please read the following carefully before completing this form. For additional information about the Complaint submission or Appeal submission process, review the information flyer. 

This form is to be completed by the person filing the affidavit for complaint investigation.  This form will be regarded as the official document upon which the complaint investigation shall have its foundation, so it is absolutely necessary that all spaces for information requested be completed. This report form is an official police report.

Please note that this form is an affidavit and when your electronic signature is affixed to it, that signature will represent (sworn/solemn) affirmation that the information contained herein is the truth. Be advised that you may be requested to submit to a polygraph examination. Should the allegation of this affidavit be untrue, and submitted with deliberate falsification or malicious intent you may be subject to criminal prosecution, or civil liability.

Any further questions or concerns you have about completing this form may be directed to the Professional Standards Unit at 803-329-7225.

If you wish to remain anonymous, please type "anonymous" in the first name and signature fields below.  While it is acceptable to remain anonymous, please understand this may limit the scope of our investigation and prevent us from following up with you if more information is needed.

 Complainant's Name

 *

Complainant's Name

Complainant's First Name:

Middle Name:

Last Name:

Address

Address

Street Address:	City:	State:(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip:
Email:

 

 *

Date of Birth:

Home Phone:ext.

Cell Phone:ext.

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 Incident

 *

Incident

Date of Incident:

Time of Incident:

Location of Incident:

 Were you arrested?

 *

Were you arrested?

Yes

If yes, state charge(s):

No

Were you injured?

 *

Were you injured?

Yes

If yes, nature of injury:

No

If injured, did you seek medical attention?

If injured, did you seek medical attention?

Yes

Where and when:

No

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 Police Department Employees Involved

	Police Department Employee Involved (if known):	Employee Number (if known):	Vehicle Number (if known):
1	Police Department Employees Involved	Police Department Employees Involved	Police Department Employees Involved
2	Police Department Employees Involved	Police Department Employees Involved	Police Department Employees Involved
3	Police Department Employees Involved	Police Department Employees Involved	Police Department Employees Involved

Witnesses

	Witness Name	Address	Phone Number
1	Witnesses	Witnesses	Witnesses
2	Witnesses	Witnesses	Witnesses
3	Witnesses	Witnesses	Witnesses

Please describe in detail in the narrative of complaint, what occurred and the nature of your complaint. Please include as
much detail as possible and be as specific as possible. Please fully explain the incident.

 *

Description

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SIGNATURE

I certify by my electronic signature below, state that this affidavit for complaint investigation is true, and I request an investigation of the matter(s) contained within.  I understand that this affidavit is an official police report.  I am advised that if the allegation(s) contained within are proven to be untrue, and if this affidavit contains deliberate falsehoods or is made with malicious intent, I may be subject to criminal charges and/or civil liability.

Enter Full Name as Electronic Signature

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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