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2. Today's Date*
   Today's Date
3. Date of Incident*
   Date of Incident
5. Complainant*
6. Date of Birth*
8. Address*
10. Phone Number*
11. Email Address*
13. Police Employee Name*
14. Badge Number
16. Witness Name
18. Witness Address
20. Witness Phone Number
22. Statement of Misconduct*
24. WISCONSIN STATE STATUTE 946.66 PROVIDES, “WHOEVER KNOWINGLY MAKES A FALSE COMPLAINT REGARDING THE CONDUCT OF A LAW ENFORCEMENT OFFICER IS SUBJECT TO A CLASS A FORFEITURE.” CLASS A FORFEITURES ARE PUNISHABLE BY A FINE NOT TO EXCEED $10,000. By submitting, I do hereby certify that this statement is a true and accurate description of the events leading to this complaint of police misconduct. Furthermore, I certify that I am aware it is unlawful to make a false complaint regarding the conduct of a law enforcement officer.
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26. 1. Receive an email copy of this form.
27. Email address

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28. Submit

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